P - 78369• REQUEST FOR ELECTRICAL INSPECTION
1 3 0 0 5 5 � �0 Minnesota Board of Electricity
� � �� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
m�� �� (651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. state. mn. us
Identity the work covered by this request:
❑NEW ❑REMODEL ❑ADDITION ❑REPAIR wi re homes�and—bv aenerator
0 to 400 Ampere �$25 i` �"'r
401 to 800 Ampere � $50
Above 800 Ampere � $75
�UITS / FEEDERS
0 to 200 Ampere � $5
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL, SIGI
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparetus �$.50
ADDITIONS TO THE GENERAL FEES
.TIFAMILY DWELLINGS (PER UNin
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Lighting Retrofit � $25 per Fixture
Center Pivot Irrigation Boom � $40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5
Separate Bonding InspecGon (� $20
Soecial Insoection � S30 oer Hour
Traffic Si nal Standard � $5 �
Su demental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for S' ns / Outline ' hli �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$&
Additional Inspectlon Trips � $20 ����5
Invesliaative Fee �
I her�vi cettifv tl�at I
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total fee is
herein on tl�e �les sleted:
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�ED WITHIN 18 MONTHS
^ FOR OFRCE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes � No Inspectfon Other Than Rough-In: ❑ Ready Now � Will Call
0 9- 0 5- 0 3 You must call the inspector when readyl Date Ready:
I certify that I am the �UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) Ciry Zp Code
1315 HILL CREST DR FRIDLEY 55432'
Section Township Range Fire No. County
ANOKA
Occupant Phone
TOM MANNING 7 3- 71-
Power Supplier Address
Electrical Contrador / Company Name Comractor License Number Master License Number
ALL
Mailing Address (Contractor, Company or Owner Perfortning Installation)
2275 N MCKNIGHT RD NORTH ST PAUL, MN 55109
Authorized Si (Contractor, Company or er Perfortni g Installation) Phone
651-770-3124
EB•00001A-13 /1/2000 BOARD OF ELECTFi1CITY COPY INSTRUC710NS ON BACK OF YELLOW COPY