P - 79601REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity =�
�. � 2e4. 2� 1 9 8 & 3 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
`�� � (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us '� '
IdentiTy the work covered by this request:
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EW ❑REMODEL ❑ADDITION REPAIR
GENERAL FEES Outdoor Liahtina Standard �$1
0 to 400 Am ere �$25
01 to 800 Am ere �$50
bove 800 Am ere � $75
CUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Anuaratus �$.50
3 to 12 UnRs �$50 Per UnR
Each Additbnal Unit � $25
OTHER ADDITIONAL FEES
Manufactured Home Park Lots �
Recreational Vehicle Park Sites �
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns I Outline Li htin �$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 Dwellin Unit �$8(
Additional Inspection Trips � $20
Investiaative Fee
that
total fee is
3in on tlre dates s�ted:
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S eciai Ins ection �$.31 per Mile ���( �'� �� f d� (1—G�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPL ED WITHIN 18 MONTHS
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FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? �Y�ea— ❑ No Inspection Other Than Rough-In: ❑ Ready N II Call
�'� �� — �� You must call the inspeclor when readyl Date Ready:
I certiiy that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (SVeet, Box, or Rout No.) Ciry Zip Code
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upant � Phone
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Power Supplier� Address ���
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Electrical Contractor / Company Name �� Contract r License Number Master License Number
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Mailing Address (CoMrec[or, C pan or Owner Pertorming Install on)
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Authorized Signature (C ct , Company or er Perf Installatlon) Phone
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EB•00001A•13 7/1/2000 � OF ELECTAICRY COPY � INBTHUC710NS ON BACK OF YELLOW COPY