P - 80467� REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
� 1-381-458 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www, e lec tricit y. s ta fe. mn. us
Identify the work covered by this request:
l.flvEW ❑ REMODEL ❑ ADDITION
401 t0 800
�
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUlTS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIOfJS TO THE GENER,4L FEES
MULTIFAMILY DWELLINGS (PER UNI
3 to 12 Units �$50 Per Unit
Fixture
XCEL ENERGY SAVER'S SWITGH
Transfortners u to 10 KVA �$10
Transfortners over 10 KVA � $20
Transformers / Power Supply for Signs / Outline Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unft �$80
Additional Inspection Trips � $20
Investi ative Fee
Reinspection Fee � $20
TOTAL FEE
(minimum total fee is $20)
FOfl INSPECTOF USE ONLV
RWOH IN
FINAL INSPECTlON
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FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-in: ❑ Ready Now � Will Call
09t2$AD1 You must call the inspector when ready! Date Ready:
I certiiy that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecirical ww�ork at:
Job Address (Street, Box, a Route No.) City Zip Code
666 KIMBALL ST NE FRIdLEY 55432
Section Township Range Fire No. County
ANfktA
Occupant .f . ,} r'' •� Phone
OL�IV Tc7DD D �c� `�` 1 1
Power Supplier Address �
XCEL ENERGY
Electrical Contractor / Company Name Contractor License Number Master l.icense Number
HUNT ELECTRIC CORP�'lRATI4N CA W883
Mailing Address (Contractor, Company or Owner Performing Installation)
2300 TERRITORI�iL ROAD , SAtNT PAUL, MN 55114
Authorizetl Signature (Contractor, Company or Owner Performi�g Installation) Phone
1
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY