P - 76386REQUEST FOR ELECTRICAL INSPECTION �
2° o V�� 7 7 3 � Minnesota Board of Electricity � ;�
❑ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 =�.'
e��(..� �b (651)642-O800TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
be -using the ba f the white copy if necessary - the work covered by this request:
G�O - 7 ' � C"
GENERAL FEES Outdbor Lighting Standard @$1
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Amcere na $25 Supplemental Fee (� $20
Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITI01
Lighting Retrofit @ $25 per Fi#ure
Center Pivot Irriaation Boom (�a $4C
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer I Power Supply for Signs / Outline Lighting @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, Ail
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTAL FEE
total fee is $20)
I herebvi certifv that I inspected the electrical installafion described herein on the dales staled: �
. �.
S cial Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12
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Dat; O l I Rough-in Inspection Required? ❑ Yes No Inspedion Other Than Rough-In: ❑ Ready Now Will Call
�� 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 Ske SVeet Address CRy
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Township Section Range Fire No. Coun
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Owner/Occupant Name � ,, Please Provide Two (2) Phone Numbers Including Area Code
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er oint Energ�
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ka, M N 55304
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�� � License Number
Please Provide Two (2) Phone Numbers I
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