P - 78595REQUEST FOR ELECTRICAL INSPECTION
1 � � � � � � � � � ° Minnesota Board of Electriciry
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity. state.mn. us
Identify the work covered by this request:
�NEW ❑REMODEL ❑ADDITION ❑REPAIR � C� � O 1" � �
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am re �$5 G
Above 200 Am re � $10
ALARM, CAMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus �$.50
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Lighting Rehofit � $25 per Fixture
Center Pivot Irti� ation Boom �$40
Manufadured Home Park Lots � $25 _ �'
Recrea6onal Vehide Park Sites � $5
Separate Bonding Inspec�on � $20
Special Inspection � $30 per Hour
Soecial Insoection � $.31 cer Mile
Su lemental Fee � $20
Trensformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transfortner / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Suppty up to 500 Amperes, All
Circuits and Two In 'on Trips Each Dwelli Unit �$8(
Additional Inspection Trips � $'LO
7lnvestiaative Fee
FOR OFFICE USE ONLY
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I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical wrork at:
Job Address (Street, Box, or Route No.) Ciry Zp Code
6464 VanBuren St. Fridley 55432
Section Township Range Fire No. Counry A n o k a
�U��t Osborne Builders ���
Power Supplier Address
XCel
Electrical CoMractor / Company Name CoMra
Bassing Electric, Inc.
Mailing Address (CoMractor, Company or Owner Perfortning Installation)
1354 McKay Dr. NE, Ham Lake, M
Authorized Siarxture (Contracto6 Com nv or er Performinp Installation)
,. - - -�--
EB-00001A43 7AM2000 � OARD OF ELECTRI
Phone
ctor License Number Master Lic:erue Number
CA00237
N 55304
Phone
763-434-3298
CRY COPY INS'Tf1UC710N3 ON BACK OF YEILOW COPY