P - 80175REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
� f-396-160 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529
www.electricity.state.mn.us ' �
Identity the work covered by this request:
O�VEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
0 to 400 Ampere �
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
ADDITIONS TO THE GENERAL FEES
iIFAMILY DWELLINGS (PER UNI�
3 to 12 Units �$50 Per Unit
Center Pivot Irrigation Boom � $4
Manufactured Home Park Lots � ;
Recreational Vehicle Park Sites �
Separate Bondinq Inspection � $E
XGEL ENEROY SAVER'S SWITCH
Su lemental Fee d $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformers / Power Su I for Si ns / Outline Li htin �
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwefling Unit �$E
Additional Insoection Trips (� $20
Reins ection Fee � $20
minimi
FOF INSPECTOfl USE ONLY
I hereby cettify that I inapected Me electricel inslaliatlan
ROUGM IN
FlW1L INSPECTqN
TOTAL FEE ��
total fee is $20)
DATE
FOR OFFlCE USE ONLY
IIIIIIIIIIIIII�I�IIIIIIIII������ /b
* 1 961 02* � '�
3 6 I� �U
RequeSipel6�� Rough-In Inspaction Required? ❑ Yes fa,No Inspection Other Than Rough-in:. C1Ready Now ❑ Will Call
Utlll A 1f
You must call the inspector when ready! Date Ready:
I certity that I am the C� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Jab Address (Street, Box, or Route No.) Ciry Zip Code
€�8Q MtS�tSSIPPI uT NE FRI[)LEY 55�t
SecGon Township Range Fire No. County A�Q�{a
Occupant (�� Phone
MELTdN Df)NALD F cl -s ._
Power Supplier Address -
�. �ca�v
Electrical Contractor / Company Name Contraclor License Number Master License Number
HUNT ELECTRIC CX3RPORATION CA 00883
Mailing Address (Contrector, Company or Owner Performing Installation)
?300 T'EI�ITORIAL t�lAO , SAINT PAUI, MN 55114
Authorized Signature (Contractor, Company or Owner Performing Installation) Phone
�51 6�6-2811
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY