P - 80023� REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1-396-129 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity.state.mn. us
IIdentity the work covered by this request:
l.FllEW ❑ REMODEL ❑ ADDITION ❑ REPAIR X�EI, ENEROY SAVER�S SW ITCN
0 to 400 A�
401 to 800
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL f
MULTIFAMILY DWELLINGS (PER UNI�
3 to 12 Units �$50 Per Unit
Each Additionai Unit � $25
OTHER ADDITIONAL FEES
Lightinq Retrofit � $25 per Fixture
Transfortners u to 10 KVA �$10
Transfortners overl0 KVA � $20
Transformers I Power Suppry for Signs ! Outline Lighting �
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unft �$E
Addftional Inspection Trips � $20
Investiaative Fee
TOTAL FEE I ZL1•5QI
FOF INSPECTOF USE ONLY
I hereby cerUy that I inspected �he electricel instellafion described herein on Ne dates :
ROUC�HIN DATE
FINAL INSVECTION //� DATE
` :�C'�' ii
FOH OFflCE USE ONLY
i Ililll ilhl �1i1 iilli II�I �III i� �� i�
* 1 3961 297* '�fZJ$ �,�
Reque�$��+� Rough-in Inspectlon Required? ❑ Yes C�NO Inspection Other Than Rough-in: �Ready Now ❑ WiU CaA
You must call the inspector when ready! Date Ready:
I certi(y that I am the a4 LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspec6un of the electrical work at:
Job Addressl�i9gt. Ba����� � NE C� ��Y �P �e �32
6691
Section Township , R 1� ir�R,NO. County A�a
� �
�upLEITSCHUH dANIEL A Pnone
Power Supplier Address
icc��.. �Y
Electrical Contractor / Com n Name Contrador License Number Master License Number
HUNT ELEC{�R�G CQRPORATIUM CA 00883
Mailing A� contract,orr, c�om�any o�r ow�ne � P,�qAI(V�PgA �U� MN 55114
Authorize ' nature (�ractor, mpany or Owner Perfortning Installation) Phone
�!'i1 �46-2D11
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY