P - 80024- REQUEST FOR ELECTRICAL INSPECTION .......,
Minnesota Board of Electricity
1-396-� 28 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/M RS 1-500-627-3529
www.e%ctricity.state.mn. us
IdentiTy the work covered by this request:
uTEW ❑ REMODEL 0 ADDITION ❑ REPAIR
to a00
ie 800
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL
MULTIFAMILY DWELLINGS (PER UNI'n
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 per Fixture
Center Pivot Irtipation Boom (� $40
XGEL ENERQY SAVER'S SWIT(:�i
� $zo
10 KVA
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Additional Insoection Tri�s � $20
FOR INSPECTOF USE ONLY
1 hereby certity that
ROUGH IN
FINAL INSPEC770N
TOTAL FEE
on me aates aretea:
DATE
DATE
� J/f G�'
FOR OFFICE USE ONLY
111111111�INIlillllf�111flllliflil��l�l ���
*, 396, 289* ao.�
Requeat���� Rough-in Inspection Required? ❑Yes G�NO Inspection O[fier Than Rough-in: 6�Ready Now pwn can
u
You must call the inspector when ready! Date Ready:
I cerCrfy that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address Street, Box, or Route No.) Ciry Zp Code
20 CHANNEL RD NE FRIDLEY 55�13�
Section Township Range Fire No. County aN�/�
Occupant � Phone
MCCLC7SKEY WILLIAM d �
Power Supplier Address
xc� ��v
Electrical CoMractor 1 Company Name CoMractar License Number Master License Number
HUNT ELECTRIC CX�RPORATION CA 00883
Mailing Address (Contractor, Company or Owner Performing Installatlon)
�D TEIiRITC�Ft1AL Rt7AQ , SAINT PAUL, MN 55114
Authorized Signature (Contractor, Company or Owner Perfortning Installation) Phone
' , ��� �51 fi4fi-2911
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY