P - 80031� REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
, 1-396-123 Q; 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. sta te. mn. us
Identity the work covered by this request
qi�lEW ❑ REMODEL ❑ ADDITION ❑ REPAIR X�EL ENEROY SAVER�S SWITGH
401 to 800 Amoere �
IALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Lighting Retrofit � $25 per Flxtu
Center Pivot Irrigation Boom � $
Manufactured Home Park Lots �
to
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unft �$t
Additional Insuection Tnos � $20
�
I hereby certify ihat � inspected Me electrical
ROUGH IN
FINAL INSPECTION /�J
.� .':
,�.��.
TOTAL FEE
total fee is $20)
DATE
DA7E
_3d�
fOR OFFICE USE ONLY
I 111�1 IHN alll II�i NI� ���� I�
* 1 3961 230* ��5�
� -SU
Requesi�g��2 Rough-in Inspection Required? ❑ Yes �No I�spection Other Than Rough-in: Q Ready Now ❑ Will Call
tJ /l X
You must call the inspector when ready! Date Ready:
I certify that I am the l}� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
d420 8AP(ER AVE NE FRICILEY 55�132
Sectlon Township Range Fire No. County ��A
Occupant �+ Phone
siNO HaR,�r � 4 �
Power Supplier Address
� �Y
Electrical Contractor / Company Name Contractor License Number Master License Number
HUPIT ELECTRIG CORPQRATION �A 00883
Mailing Address (CoMraaor, Company or Owner Performing InstallaHOn)
2300 TERIiIT�RIAL R�AD , SAINT PAUL, MN 55114
Authorized Signature (Contractor, Company or Owner Perfortning Installation) Pfione
�i1 �46-2911
EB•00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY