P - 80002' REQUEST FOR ELECTRICAL INSPECTION ... .,
.. � Minnesota Board of Electricity �.
1-396-166 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTYJMRS 1-800-627-3529
www. e%ctricity.state.mn, us '
Identiiy the work covered by this request:
O�EW ❑ REMODEL ❑ ADDITION
CIRCUITS. CIRCUITS OF LESS THAN 5� VfJLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL I
Lots
� $.io p2f FIOUf
� $.31 per Mile
to
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$SO
Additional Inspection Trips C� $20
Investigative Fee
Reinspection Fee � $20
TOTAL FEE
(minimum totai fee is $20�
wR �svECroa us� a�nv
I hereby certify Nat I inspectetl Me
ROVGH IN
FINAL INSPECTION
ates steted:
DATE
.- °� I
FOH OFFICE USE ONLY
illIIIIIIIiIIIIIINNIHIIIill�lll��lif�l�l �
* 1 3961 669* ��
02 Q.S�
Request Date: Rough-in tnspection Required? ❑ Yes ❑ No Inspection Other Than Rough-in: ❑ Ready Now ❑ Will Call
���� You must call the inspector when ready! x Date Ready: X
I certity that I am the l,� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the eiectrical work at:
Job Address (Street, Box, or Route No.) Zip Code
7�0 OVERTf�1 DR hE � FRIDLEY 55�32
Section Township Range F've No. Counry ���A
Occupant Phone
NELSON JANET 8
Power Supplier Address
��
Electrical Contractor ! Comparry Name Contractor License Number Master License Number
HUN'f ELEGTRIC �7QRPORATION GA t�D883
Mailing Address (Contractor, Company or Owner Performing Installation)
2300 'IERKlTC1RIA� ROAa , SAINT PAUL, MfV 55114
Authorized Signature (Contractor, Company or Owner Performing Installation) Phone
�,�y�ywy( �51 648-2911
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY