P - 80011- REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
, 1-396-138 � 1821 University Avenue Suite S-128, Saint Paui, Minnesota 55104 -
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us '
IIdentity the work covered by this request:
0'I�EW 0 REMODEL ❑ ADDITION ❑ REPAIR
0
TION, REMOTE CONTROL, SIGNALING
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Lighting Retrofit � $.25 per Flxture
Center Pivot Irrigation Boom � $40
XC�L ENEROY SAVER'S SWtTCH
Transfortners u to 10 KVA �$10
Transiormers over 10 KVA � $20
Transformers / Power Supply for Signs / Outline Lighting �$!
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, Ail
Circuits and Two Inspection Trips Each Dwelling Unit �$SO
Additional Inspection Trips � $20
ROUGH IN
FlNALINSPECTION
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TOTAL FEE
totalfee is $20)
DATE
DATE
z. • Si- �-
FOR OFFICE USE ONLY
I IIII�I (IIII �III IIIII �IIII IIIII (III� I�III �� (�I Tl��
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* 1 3961 388'` �1•�
Reque�f ���2 Rough-in Inspection Required? ❑ Yes t�No Inspection Other Than Rough-in: � Ready Now ❑ Will Call
You must call the inspector when ready! Date Ready:
I cerli(y that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
.iob naare��834' B�FIA�MAIVN AVE NE �� FRIC�EY zp coaa 55432
Section Township Range Fire No. County A��ia
Occupant Phone
KUCERA DaRETTA V
Power Supplier Address
�L �Y
Electrical Conhactor ! Company Name Contractor License Number Niaster Ucense Number
HUNT ELEGTRIC OORP4RATION CA 00883
Mailing Address (Contractor, Company or Owner Performin Installadon)
23�0 TE4'�21TC'1RIAL 124AD , SAIN�PAUL, MN '55114
Authorized Si nature (Contrecto� r,� r Owner Performing Installation) Ptwne
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EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY