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P - 81791REQUEST FOR ELECTRICAL INSPECTION � � � � � � � p � � Minnesota Board of Electricity L} 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 � a� (651) 642-0800 TTY/MRS 1-800-627-3529 � ! www.electricity.state.mn.us '� � � Identify the work covered by this request: ❑NEW ❑REMODEL DADDITION ❑AEPAIR � GENERAL FEES Outdoor Li htin Standard �$1 SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5 0 to 400 Am ere �$25 Su lemental Fee �$20 401 to B00 Am ere �$50 Transtormers u to 10 KVA �$10 Above 800 Ampere �$75 Transtormers over 10 KVA �$20 0 to 200 Ampere � $5 Above 200 Ampere � $10 RM, COMMUNICATION, REMOTE CONTROL, SIGI �UITS, CIRCUITS OF LESS THAN 50 VOLTS Each System Device or Apparatus �$.50 ADDITIONS TO THE GENERAL FEES ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes the Service ancUor Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dwelli Unit �$8C Additional Inspection Trips � $20 Investiaafive Fee 3 to 12 Units �$50 Per Unit (minimum total fee is $ Each Add'Rional Unit �$25 F0R1N�1°"'�E 0NL1 OTHER ADDITIONAL FEES Li htin Retrofit �$25 er FuRure Center Pivot Irri a6on Boom �$40 ManufBCtured Home Park Lots �$25 I hereby cerMy that I ins ed the electrical installa6on described herein on the dates afated: Recreationat Vehicle Park Sites �$5 H01GH1N Dq7F rate Bondin In ion � $20 S ial Ins ection �$30 r Hour � �^� S ial Ins 'on �$.31 r Mile ' � o'Z THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF T COMPLETED WITHIN 18 MONTHS FOR OFFlCE USE ONLY t ��i��� i��« ����� ����i ��i�� �a�� ��l�i ��ii ��il .� �aa� � �E 1 O 9 5 5 4 8 2�E ��'�� Requ ate: Rough-in Inspection Hequired? ❑ Yes ❑ No Inspeclion OMer Than Rough-In: dy Now � Will Catl � / You must call the inspector when ready! Date Ready: I ceAify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspedion of the electrical work at: Job Address (Street, x, or Route No.) Ciry Zp Code �C3 �� � �.e ,l' . �s 3�? Section Township Range . Fire No. Counry n � 619 Coon R � c EB-00001A43 < < Phone J � ' � O� � Name Coryractor Lioense Number _ Masj�r License Number gr�Qa���yPejaQpg Installation) Bivd. NW er Performing Installation) eo�r+o oF �cr�ucm ` �J ��L�JYJ I INSTpUCT10NS ON BACK OF YELLOW COPY