P - 79930� REQUEST FOR ELECTRICAL INSPECTION _E.
Minnesota Board of Electricity
1-396-180 � i821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. sta te. mn. us
Identiiy the work covered by this request
Ut�EW ❑ REMODEL ❑ ADDITION 0 REPAIR �L ENEROY SAVER�S SW�TCH
to
bove 800
IITS / FEI
to 200 Ai
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or A paratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNI�
310 12 Units �$50 Per Unit
Lighting Retrofit � $25 per Fixturi
Center Pivot Irrigation Boom � $4
Manufactured Home Pask Lots �
Recreational Vehicle Park Sites �
Mile
Transformers u to 10 KVA �$1�
Transfortners over 10 KVA � $20
Transfortners / Power Su I for Si ns / Outline Li htin �$5
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 �$60
Additional Inspection Trips � $20
Investi ative Fee
Reins on Fee � $20
TOTAL FEE
(minimum total fee is $20)
i ner�y certny mec i
ROUGH IN
DATE
DATE
^ /1.,2.{�.d,�
IR MANTHC
FOR OFFiCE USE ONLY
i I Il III IHN N�I II I� �III �� ��l I� 1�
* 1 3961 800* �f��� o�'�
Reque��/Q'2 Rough-in Inspection Required? ❑ Yes l�No Inspection Other Than Rough-in: � Ready Now ❑ Will Call
You must call the inspector when ready! Date Ready:
I certi(y that I am the � LICENSED CONTRACTOR ❑ COMPANY O OWNER and hereby request inspection of the electrical work at:
Job Addres��, ea���Y ��� c�ri F�� Ua coae ��
Secdon Townsh(p Range Fire No. County A�A
��U�b�AN04UIST JiM 0 � � � Phone
Power Supplier Address
�.. �Y
Electrical Contractor / Com ny Name Contractor License Number Master License Number
HUNT ELEC�RIG CORPORATION CA 00883
Mailing Ad� cootractTORI�Y�� � SAINI�P�B�� IrIN �114
Authorized i nature (�dor, Company_ or Owner Performing Installation) Phone
�iw��f a5i �z91 �
EB-00001A-13 7!1l2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY