P - 776851Q�`/@ REQUEST FOR ELECTRIC L INSPECTION �
� V C� °� 4 9 4 ��' Minnesota Board of Electricit ��Jj � `� ��� ��:
1821 University Avenue Suite S-128, Saint a�lUinn�o�55104� k �`
(651) 642-0800 TTY/MRS 1-800-627-3529 www. electricity. state. mn. us
Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Li htin Standard @$t
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am ere $ �'? ` Supplemental Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am ere $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer I Power Su I for Si ns / Outline Li htin $5
0 to 200 Am re $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re$10 Includes the Service andlor Power Supply up to 500 Amperes, Ail
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s $20
Each System Device or Apparatus @$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins tion Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FE j � �—�,
3 to 12 units @$50 Per Unit (minimum total fee is $20 �< '�
Each Additional Unit (� $25 THISAREAFOftINSPECTORU5E0NLY
Park Lots (
Park Sites
THIS INSTALLATION MAY BE ORDERED
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18644945
I hereby certify that I inspeded the electrical installatlon described herein on ihe dates stated: �
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NECTEDJF NOT
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12 MONTHS
/ Rough-in Inspection Required? ❑ Yes � No Inspedion Other Than Rough-In: ❑ Ready Now�Wili Call
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J ' 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 SRe Street Address C�,
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Township Section Range Fire No. County
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actor / Company Name
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ig A3dress (Contractor, ompany or Owner P�
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orize Sigi � � ntrador or Owner Perfor
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conVactor License Number Master Electrician or Power Limfted Technician
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Installation)
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311ation) Please Provide Two (2) Phone Numbers Including Area Code
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