P - 77050REQUEST FOR ELECTRICAL INSPECTI�JN � �'�
1� 7� d- 9 2 6 � Minnesota Board of Electricity v�(.bs rL��o � �-
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55 �
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
1
GENE FEES Outdoor Li htin Standard @$1
SERVICES I POWER SUPPLIES Traffic Si nal Standard @$5
0 to 400 Ampere @$25 Suoolemental Fee C�D $20
Above 200 Am ere �$t0
ALARM, COMMUNICATION, REMOTE CANTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apoaratus fa� $.50
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofd @ $.25 per Fixture
Center Pivot Irriqation Boom a(� $40
S cial Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDEREI
IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII N�� I�Y
1926926�
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins edion Tri s $20
Investi ative Fee
Reins ection Fee $20
TOTALFEE
(minimum total fee is $20) O�� So
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I hereby certify that I inspeded Ne electrical installation desaibed herein on the dates stated:
IF NOT COMPLETED WITF
..,v � E �.m.
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vace: Rough-in Inspection R uired?
eq ❑ Yes o Inspedian Other Than Rough-In: ❑ Ready N 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 Site SVeet Address ��y
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� Township
:'i�f:e Electric Services
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Range Fire No. ty � �
Please Provide Two 2) Phone Numbers Including Area Code
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fress
Co or License Number Master ElecVidan or Power Limited Techni�
License Number
� Plea vide Two�ne N bers InGuding A�e
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