P - 77674REQUEST FOR ELECTRIC INSPECTION ��`'���F"'
1� p� o� 4 9 9 0 Minnesota Board of Electricity �( _���� w ,'�,�
1821 University Avenue Suite S-128, S�n��aul°Min o ^�
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.sfute.mn.us
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Describ -using the back of the white copy if necessary - the work covered by this request:
GENERAL FEES ,� Outdoor Lightin Standard @$1
SERVICES / POWER SUPPLIES Traffc 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 ere $75 Transformers over 10 KVA $ 20
CIRCUITS I FEEDERS _. Transformer I Power Su I for Si ns I Outline Li htin $5
0 to 200 Am ere $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s a'� $20
Each S stem Device or Apparatus $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ction Fee $20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to �2 Units @$50 Per unit (minimum total fee is $20)
EeCh Additi0�21 Unit @$25 rHis aaEn Foa wsPECroR use ow�r
OTHER ADDITIONAL FEES �� �
Lighling RetrOfit @$.25 per FiXtufe I hereby certify ihat I inspected the electrical installation described herein on the dates stated:
Center Pivot Irrigation Boom $40 RWC"'" oarE
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5 F�� �NSrecnoN �, onre
Se arate Bondin Ins ection $20 r�-Q--�"''�"-- (° � 2�� 4
SpBCl81 IfISp2Cii0n $30 p2f HOUf ExaiaEO �nanHOONeo on�
Special Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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1880499�
Date: Rough-in Inspection Required? ❑Yes W No Inspection Other Than Rough-In: �Ready Now ❑Will Call �
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� 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 Site Street Address S � � � � City �� , � /
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Township Section Range Fire No. County L
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Owner/Occupant Name Please Provide Two (2) Phone Numbers Including Area Code
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Electrical Utility Electrical Utility Address
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Contractor / Company Name Contractor License Number Master Ele rician or ' er Limited Technician
S � `/C G % __'. � ��O � /�O� License Number
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Mailing Address (ConVactor, Company or Owner Performing Installation)
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Authoriz � ture (Contractor or O e edorming Installatlon) Please Provide Two (2) Phone Numbers Including Area Code
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