P - 80028.�`` REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board oi Electricity
1-396-125 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 -
(651) 642-Q800 TTY(MRS 1-500-627-3529
www. electricity. siate. mn, us
Identify the work covered by this request:
D�EW ❑ REMODEL ❑ ADDITION ❑ REPAIR
to
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNI'n
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Liah6nq Retrofd � $25 oer Fixture
Standard
ndard �
Transformers u to 10 KVA �$10
Transfonners overl0 KVA � $20
Transfortners / Power Suppty for Signs / OuUine LiUhting �$5
ONE & TVJO 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 $20)
FOF INSPECTOF USE ONLV
ROUGHIN
FINAL INSPECTION
oare
DATE
3-�
FOR OFFICE USE ONLY
IINIIIINIINIIIIII{II{il{IIIIIIINI�ill��in{ ����
I *13961255* �d"�
Reque§�Q$�g�� Rough-in Inspection Required? ❑ Yes aNO Inspection Other Than Rough-in: aReady Now ❑ WiU Call
�gl� You must call the inspector when ready! �S Date Ready: „
I certi(y that I am the [� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the etectrical work at:
Job Address (Street, Box, or Route No.) City Zp Code
1558 BRIARDALE RD NE FRiDLEY 554
Seetion Township Ran t C Counry Ai�1�A
Occupant Phone
VARICHAK STEPHEN PAiJL
Power Supplier Address
��
Electrical Contractor / Company Name Contrector License Number Master License Number
HUNT ELEGTRIC CxIRPORATIOM CA OQ883
Mailing Address (Contractor, Company or Owner Performing Installation)
�3t10 TEAlZITORIAL R�Ad , SAtNT PAIA., MN 55114
Authorized Signature (Contractor, Company or Owner Perfortning Insfallation) Phnne
� �� 851 646-Z911
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY