P - 76605REQUEST FOR ELECTRICAL INSPECTION ����
1��� o- 4 4 2� Minnesota Board of Electricity � �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
(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 @$1
SERVICES I POWER SUPPLIES Traffic Siqnal Standard (a) $5
401 to 800 Am ere $50
Above 800 Am ere $75
CIRCUITS I FEEDERS
0 to 200 Am ere $5 /� �—��
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Liqhtinq Retrofit (�a $.25 oer Fi#ure
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THIS
� Transformer I Power Supply for Signs / Outline Lighting @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investiaative Fee
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TOTAL FEE I �,.�
ninimum total fee is $20)
A �� �f}R�OR��ECTORUSEONLY / .
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tlinspectedthe electncalin talation described hereiw
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H�Uf EXPIREDINd4NDONE� pp�
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4Y BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 72 MONTHS
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ua[e: Rou h-in Ins ection Re uired?
�� '�� �� � g p q ❑Yes �] No Inspection Other Than Rough-In: Ready Now ❑Will Call
You must call the inspector when ready! Date Ready:
I certify that I am the 0 LICENSED CONTRACTOR ❑ COMPANY f�( OWNER and hereby request inspection of the electrical work at
Job Site� t Address_ �� �� C�y �, /
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Township Section Range Fire No. Cou
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Own r/Occupant Name Please Provide Two (2) Phone Numbers Including Area Code
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al U61ity ElecUical Utility Address
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ctor / Company Name Contrador License Number Master E�ectrician or
License Number
Address (Conhactor, Company or Owner Performing Installation)
;ase Provide Two (2) Phone
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Technician I
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