P - 79991REQUEST FOR ELECTRICAL �NSPECTION
Minnesota Board of Electricity "�
1-396-� 70 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 -
(651) 642-0800 TfY/MRS 1-800•627-3529
www. e%ctricity. s ta te. m n. us
Identify the work covered by this request:
O�EW ❑ REMODEL ❑ ADDITION ❑ REPAIR
401 to 800 Am ere �$50 Transfortners u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transfomiers / Power S for Si ns / Outline Li htin �$;
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service and/or Power Suppry up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING Gircuits and Two Inspection Trips Each Dwelfing Unit �$80
CIRCUITS. CIRCUITS QF LESS THAN 50 VOLTS Additional Insoection Trios 8$20
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Lighting Retrofit � $25 per Fixture
Cerder Pivot IrriQation Boom f� $40
TOTAL FEE
total fee is $20)
me dates satea:
ROUGHIN DqTE
FINAL INSPECTION �ATE
� � �
FOR OFFICE USE ONLY
I II�III �IIII II�I IIIII II�I� I��I� ��� � 1��
* 1 3 9 6 1 7 0 1* l�?� �,S-0
Request Date: Rough-in Inspecfion Required? ❑ Yes ❑ No Inspection Other Than Rough-in: ❑ Ready Now ❑ Nfill Cel{
�� 8� You must call the inspector when ready! x Date Ready: x
I certify that I am the f� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work aT.
Job Address (Street, Box, or Route No.) City Lp Code
290 RK;E [�EEK BLY NE FRIIX.EY 55�{3
Section Township Range Fire No. County A�A
Occupant c� phone
HUFF LA REE E �G e� �
Power Supplier Address
�. �Y
Electrical Contrector ! Company Name Contractor License Number Master License Number
HUhR ELECTRIC C4RPORATION CA 0088�
Mailing Address (Contractor, Company or Ownflr Pertortning Installadon)
2300 �aarTaaia� �aa , SAtNT PAUL., QAN 55114
Authorized Signature (Contractor, Company or Owner Perfortning Installation) Phone
fi5'I 6�16-2�11
EB-00001A-13 7/1/2000 BOARD OF ELECTFICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY