P - 77598']c REQUEST FOR ELECTRICAL INSPECTION •' �`�
1�� 1�3 - 510 9� Minnesota Board of Electricity r
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �'
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
De�qj����e back of the �ryb�/pecessary - the work covered by this request:
SOG GENERAL FEES Outdoor Lightin Standard @$1
SERVICES I POWER SUPPLIES Traffic Si nal Standard @$5
0 to 400 Ampere @$25 /La �� Supplemental Fee @$20
401 to 800 Am ere $50 Transformers u to 10 KVA $10
Above 800 Am ere $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer I Power Su pl for Si ns / Outline Li htin $5
�F 0 to 200 Am ere $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere $10 Includes the Service and/or 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 ection Tri s $20
Each System Device or Apparatus @$.50 Investigative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee @$20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE
3 to 12 Units @$5o Per Unit (minimum total fee is $20)
EechAdditi0f181Unit@$25 rrrisneenFOaiNSaecTOauseoN�r ,
OTHER ADDITIONAL FEES
Li htin Retrofit @$.25 per FixtUre I hereby certify that I inspected the elecirical installation described herein on the dates stated:
Center Pivot Irri ation Boom @$40 RoueH w _ onre
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Manufactured Home Park Lots S25 �.- ��- =—y �� 2- Z� �
Recreational Vehicle Park Sites $5 f�NA� �NSPecT�oN /oA,E �
Se arate Bondin Ins ection $2Q � /—d
S ecial Inspection @$30 per Hour exaiaeo aaaNOONeo oarE
Special Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS __
I' I� II �- -��y
� I�H �� �H �� ��� �� IN (� ��� �� N� �I ��� �� �� �) (�I � ��N
17755L09 ������Z
Robert Clauson
Dat
�(651) 777-7885 Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
� You must call the inspector when �y! I Date Ready: �
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I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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I Job Ste Street Address� �City
�,� Tow �� , Section '. Range Fire No. '� C
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Owner/Occupant Name � � � �. p eaj se Provide Two � �Numbers Including Area Code �
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, Elec �;a�n�OmeS '�, Elechical Utility Address -
ContlRr��r�tNS`P� - 3115 Centre f�9110�B��DtI'Ve)s¢�qgip�jl g, st§� iei Technician
� License Number
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� Maili�� �'���y�����a�rperforming Installatwn) � �- �]��Q�-4r�� ��� � ��
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�; A� igr� ��( t At{�{y�yr►i� ���u�� 55304 I�lease Provide Two (2) Phone � mbers Including Area Code
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