P - 77037REQUEST FOR ELECTRICAL INSPECTION ���'�'�
1`O � o� 4 7 9� Minnesota Board of Electricity 4 '��,
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �. -�,.�
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us �;�*
Describe - ng the back of e white copy if necessa the work covered by this request:
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GENERAL FE S Outdoor Li hting Standard @$1
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Ampere $25 Supplemental Fee @$20
401 to 800 Am ere $50 Transformers u to 10 KVA $10
Above 800 Am re $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 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 CANTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addflional Insoection Trios l� $20
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lightin Retrofit $25 per Fixture
Center Pivot Irriaation Boom C�D $40
Special Inspectlon a$30 er Hour
Special Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED C
11111 II III Illii I�ii� IIIII II11111111 IIIII �� I�
18204792
TOTAL FEE (
total fee is $20) ,� �, J�
I hereby certity that I inspec[ed the electrical installation described he2in on the dates stated: �
APLETED WITHIN 12
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Date: Rough-in Inspection Required? ❑Yes o Inspection OtherThan Rough-In: ady Now ❑Will Call
'� 2�� v� You musl call the inspector when ready! Date Ready:
I certify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job SRe Street Address
City
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Township Section Range Fire No. Cou
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Owne�(Occupant Name Please Provide Two (2) Ph ne Numbers Including Area Code
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Electrical Utility Electripl Utility Address
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or / Compa
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Master ElecUician or
License Number
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