P - 80173REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1-396-164 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
(651) 642-0800 TTY/MRS 1-500-627-3529
www. electricity. sta te. mn. us
Identify the work covered by this request:
O�IEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
401 to 800 Ampere �
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or paratus (� $.50
ADDITIONS TO THF GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNI�
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 er Fixture
Center Pivot Irri tion Boom �$40
Manufactured Home Park Lots � �25
;RQY SAVER'S SW
Outdoor Liahtina Standard �
Transfortners over 10 KVA � $20
Transfortners / Power Supply for Signs / Outline Ligh6ng �
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$f
Additlonal inspection Trips � $20
fOR INSPECTOR USE ONLY
ROUGN IN
FlNAI INSPECTION
Fee �
TOTAL
d fee is
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OATE
FOR OFFICE USE ONLY �
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RequestaD�a,t'e8�2 Rough-in Inspectlon Required? ❑ Yes C]_NO Inspection Other Than Rough-in: l� Ready Now ❑ Will Call
You must call the inspector when readyl �� Date Ready: ��
I certity that I am the t� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) City Zp Code
1224 dNdWDAOA WAY NE FRIDLEY 55432
Section Township Range Fre No. County A�A
6
Occupant -'1 � Phone
CHERMACK SUSAN M 1 / �
Power Supplier Address
x�. �v
Electrical Contractor / Company Name Contrector License Number Master License Number
HUNT ELEGTRIC C)ORP�I?RATIQN CA 04883
Mailing Address (Contrador, Company or Owner PeAorming Installation)
2300 TERRiTO1�lAL F�AG , SAINT PAUL, MN 55114
Authorized Signature (Contracfor, Company or Owner Performing Installation) Phone
� ,�p� 651 646-2911
EB-00001A-13 7/1/2000 BOARD OF ELECTRICIN COPY INSTRUCTIONS ON BACK OF YELLOW COPY