P - 79932` REQUEST FOR ELECTRICAL INSPECTION ,
r Minnesota Board of Electricity �
1-396-178 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 :` -
(651) 642-OS00 TTY/MRS 1-800-627-3529
www. electrici ry. state. mn. us
Identity the work covered by this request:
�'17EW ❑ REMODEL D ADDITION D REPAIR XGE� ENERQY SAVER�S SWITCH
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Sianal Standard �$5
Above 800 Am ere � $75
CIRCUITS I FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
Each Additional Unit � $25
OTHER ADDITIO
Lighting Retrofit � $25 per Fixture
Center Pivot Irrigation poom (� $4(
Manufactured Home Park Lots � 9
Recreational Vehicle Park Sftes �
Separate Bond'mg Inspection � $2
Special Inspection � $30 per Hour
10
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unft �$E
Additional Inspection Trips � $20
Ihereby�
ROUGH IN
D IF
TOTAL FEE
total fee is $20)
herein on Me aates stete
ORTE
DATE
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FOR OFFlCE USE ONLY
I III�II IIII� �IIII IIIII �III) I��)1� � � �.,I � �
* 1 3961 784* �1� ���
Reque���2 Rough-in Inspection Required? ❑ Yes C�Na Inspection Other Than Rough•in: f�Ready Now ❑ Will Call
You must call the inspector when ready! Date Ready:
I certity that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address�S)r��, Box�� g�te,�J �v � c�ry FR��� Zip Code ���
lJU ARLITE
Sectlon Township Range Fire No. County A�A
r -,
o�uPHULTIN SHIRL.EY Phone
Power Supplier Address
� �Y
Electrical Contractor / Com an Name Contractor License Number Master License Number
HUNT ELE4"�R�C C)ORP4RATION CA 00893
Mailing qsi� g� ��„�Qrp�y�oyvn r, p�A n�g,�,i� � tio�N 55114
'I�W t�tl A[� F'
Authoriz ' nature (�ractor, ompany or Owner Performing Instellation) Phone
651 B�Ifi-2911
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY