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P - 78514> REGIUEST FOR ELECTRICAL INSPECTION �; 3 4 7 4. O 4 � Minnesota Board of Electricity � � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �'����� (651) 642-0800 Tl'Y/MRS 1-800-627-3529 www. electrici ty. state. mn. us IdentiTy the work covered by this request: �n���� �!/� j� � G� /.T-. � / !�� /'/1 yv�i'/Y�Y� ❑NEW ❑REMODEL �ADDITION EPAIR GENERAL FEES Outdoor Li htin Standard �$1 SERVICES / POWER SUPPLIES Traific Si nal Standard �$5 0 to 400 Am re�$25 Su lemental Fee �$20 401 to 800 Am re�$50 Transformers u to 10 KVA �$10 Above 800 Am re �$75 Trensformers over 10 KVA �$20 CIRCUITS / FEEDERS Transformer / Power Su for S' ns / Outline L' hti �$5 0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNR Above 200 Am re�$10 Includes the Service andlor Power Suppty up to 500 Amperes, All ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Tri Each Dwelli Unit �$80 CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional In ction Tri �$20 Each S stem Device or A ratus �$.50 Investi ative Fee ADDITIONS TO THE GENERAI FEES Reins ion Fee �$20 MULTIFAMILY DWELLINGS PER UN TOTAL FEE 3 to 12 Units (� $50 Per Unit (minimum total fee is $20 Each AddlUOnal Unit � $25 F0fl1N�`�0fl "� °NLV ?% OTHER ADDITIONAL FEES �6�, /_Q�q CJ�/' S Li Min Retrofit �$25 r Fixture � � Center Pivot Irri ation Boom C� $40 Manufactured Home Park Lots $25 I hereby cerMy that I inspecied tlre electrical insrallaiion described f�ere� on the deres smted: Recreadonal Vehide Park SRes $5 fl01�"" �h Se rate Bondin Ins ection (� $20 S ial Ins 'on (� $30 er Hour """"�"'"0N �'� S ial Ins 'on �$.31 r Mile �a� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPL TED WITHIN 18 MONTHS � FOR OFFICE U8E ONLY _---------- �,.. ��� I IIIIII IIIII I�III IIIII I{II I IIl1l 1111i IIIII III! lili p� I �� � �E 1 3 4 7 4 O 4 4�E p?�V �'Q I�09 Requ Date• Rough-in Inspection Required? ❑ Yes � No Inspection Other Than Rough-In: ❑ Ready No ill Call You must call the inspector when ready! Date Ready: I rti(y that I am the�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: Job Address (Street, Box, or Route No.) Cily Zp Code I � ' ����3 Sect n Township Ra e Fire No. Coun v Ndd OccupaM � � Phone �2�._ __ /'�,__ .�_ �_� �1 License Number � Master or 6wner Perfortning InslallaGon) I P�ne I (�/1��;/T��!'�% 7 I BOARD OF ELECTAICRV COPY �X'�STRUC710N3 ON BACK OF YELLOW COPY