P - 80029� REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1-396-124 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642•0800 TfY/MRS 1-800-627-3529
www. electricity.state.mn. us
Identify the work covered by this request:
O�EW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
SERViCES i POWER SUPPLIES
800
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or A aratus �$.50
ADDIT�ONS TO THE GENERAL FEES
MULTIFAMILY DWEI�INGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin RetrofN �$25 per Fxture
CeMer Pivot Irri ation Boom �$40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5
Se arate Bondin Ins ion �$20
S ecial Ins 'on �$30 er Hour
Special Inspection � $.31 per Mile
�
Fee
T�ansfortners overl0 KVA � $20
Transformers / Power Supply tor Signs I Outline Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Additional Inspection Trips � $20
Investi ative Fee
Reinspection Fee � $20
TOTAL FEE
(minimum total fee is $20)
I hereby certify that I inspecled the electrical installaOOn describetl herein
ROUGH IN
FINAL INSPECTION .
DATE
0
FOR OFFlCE USE ONLY
I�IIIII �I�II II�I� IIIII II�II IIIII ��� I�) �
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*13961248* aa,so
Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-in: ❑ Ready Now ❑ Wfll Call
U$/181�2 You must call the inspector when ready! X Date Ready: X
I certity that I am the [� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
6274 8EN M�RE DR NE FRIDLEY 55+i32
Section Township Range Fire No. County a�Ki�
Occupant A � � phone �
WESTt1VER BRIAId L ,��,�i
Power Supplier Address
�. ��
Electrical Contractor / Company Name Contraclor License Number Master License Number
HUNT ELEGTRIG GQRPQRATIQM CP+ 00883
Mailing Address (Contractor, Company or Owner Perfortning Installation)
23d0 TERRIT�RIAL �AO , SAIMT PAUL, MN 55114
Authorized Signature (Contractor, Company or Owner Perfortning Installatlon) Phone
�51 �4�7911
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY