P - 79987REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1-396-172 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 — _
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electricify. sta te. mn, us
ldentiiy the work cavered by this request:
❑MIEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
� ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
istem Device or Apparatus � $.50
ADDITIONS TO THE GENERAL FEES
Y DWELLINGS (PER UNIn
Pivot
�IiI�B
1CCEL ENEROY SAVER'S SWITCH
� Transfortners / Power Suppfy for Signs / Outline Lighting �$!
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 Unit �$80
Additional Insuection Trins � $20
ROUGH IN
fINAL INSPECTION
Fee �
TOTAL FEE
total fee is $201
herein onthe Oe1es steted:
FOR OFFlCE USE ONIY
1 Illlfl IHiI lilll �i� iilii �III �Ifl i�ii II� I�I
* 1 3961 727* ��?
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RequeSLQs(ry$�,2 Rough•in Inspection Required? ❑ Yes allo Inspection Other Than Rough-in: aReady Now ❑ Will Call
asri ac x
You must call the inspector when ready! Date Ready:
I certify that I am the }� LICENSED CONTRACTOR ❑ COMPANY O OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) Ciry ZiP Code
741 RICE CREEK TER NE FRIDLEY `�'��
Section Township %�yYr y, Fire No. County �a
� i f
Occupant Phone
KRAWCZYNSKI SHELLY S
Power Supplier Address
� �ERCv
Electrical Contractor / Company Name Contrector License Number Master License Number
HUhR ELEGTRiC �ARP4RATION GA �883
Mailing Address (Contractor, Company or Owner Performing Installation)
2300 TE{�1TOiilAL RaAO , SAINT PAUL, MN 55114
Authorized Signature (Contractor, Company or Owner Performing Insfallation) Phone
� �� +D51 8�2911
EB-00001A-13 7!1/2000 BOARD OF E�ECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY