P - 76507REQUEST FOR ELECTRICAL INSPECTION '�
1� O��� 4 6 2� Minnesota Board of Electricity k: ;�
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651�042-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the back of the white copy if necessary - the work ered by this �equest:
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GENER4L FEES Outdoor Lightin Standard @$1
SERVICES / POWER SUPPLIES Traffic Signal Standard $5
0 to 400 Ampere $25 / � Supplemental Fee @$20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am re $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 & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s $20
Each System Device or A aratus $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE
3 to 12 Units @$50 Per Unit (minimum total fee is $20) �� �--C
Each Additional Unit @$25 THIS FFEA FOR INSPECTOR USE ONLY
OTHER ADDITIONAL FEES
Li htin RetfOfit $25 f Fi�RufO I hereby certity that I inspeded the electripl installation desaibed herein on Me dates stated:
Center Pivot Irri ation Boom $40 Rouc� �" oA*E
Manufactured Home Park Lots $25
Recreational Vehicle Park Sftes $5 F�r� �NS�cr�or� _ oA,�
Se arate Bondin Ins tion $20 �^ r� , G��
Speciallnspection $30pefH0Uf �'P1�°1ABAN°0N oATE
Special Ins ection $.31 r Mile
_ THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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y��` �� g pectian Required? ❑ Yes �o Inspection Other T an Rough-In: �teady Now ❑ Will Call
You must call the inspector when ready! Date Ready: �—'�—�(� �
I certify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site SVeet Address
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Township Section Range Fire No. � Coun
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Oy�r/Occupant Name Please Provide Two 2 hone Numbers Including Area Code
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Electrical Utility ElecVical Utility Address
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C_ ont�c�r / Com an�N � ^ Cont� r L^ �� umber Master ElecVician or Power Limited Technician
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1�� J v�^ v License Number
Mailin Address (Contractor, Company or Owner erfortning Installation) ,
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ed Signature ontra or or er e rming Installation Please Provide Two (2) Pho e Numbers In ing Area Code
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IN TRUCTIONSON O LLOWC PV BO RDOFELECTRICINCOPVi cesnnme_�v o. o..�,.