P - 81999REQUEST FOR ELECTRICAL INSPEGTION
Minnesota Board of Electricity
�� 0 J�-118 �; µ 1&21 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529
�� � � � � Q ,� I' � � �, www.electriciry.state.mn.us ''�' —
❑ NEW EMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
SERVICES ! POWER SUPPLIES
0 to 400 Amoere � $25
Above 800 Ampere � $75
�UITS ! FEEDERS
0 to 200 Ampere � $5
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL,
�UITS, CIRCUITS OF LESS THAN 50 40LTS
Each Svstem Device or Aooaratus �$.50
Retrofit � $25 oer Fixture
�
Outdoor Li htin Standard � $1
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformere overl0 KVA � $20
Transformer i Power Su ior Si ns / Outline Li h6n �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Suppty up to 500 Amperes, All
Circuits and Twu Inspection Trips Each Dwellin Unit �$8C
Additional Insoection Trios � $20
I herebvi certi(V ihat I
Fee �
total fee is $20) 6O'�
TFi1S INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WI
FOR OFFlCE USE ONLY
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N 18 MONTHS
Request uate: Rough-in Inspection Required? `�Yes [� No Inspectlon Other Than Rough-In: ❑ Ready Now�Wtll�Call
7-1 3— � 1 You must call the inspector when ready! Date Ready:
I certify that I am the �;LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) Ciry Zip Code
1525 Berne Road NE Fridley 55421
Section Township Range Fire No. County
Anoka
°�°�"` M i k e E b e r t � g��' � Phone
Power Supplier Address
� a s�s i n g r��� e c t r i c, I n c. cam�A �2 ��r Master Lkense Number
Mailin Address (Contractor, Company or Owner Performing Installation)
13�4 McKay Drive NE, Ham Lake, MN 55304
Authorized Signature (Contractor, Company or Owner Performing Installation) Phone
� 763-434-3298
OWOtA-13 7/1l2000 BOAAD OF ELECTRICITY COW INSTNUCTIONS ON BACK OF YELLOW COPY