P - 76558REQUEST FOR ELECTRICAL INSPECTION �
1� 7 81- 912 9 Minnesota Board of Electricity �e'�'
❑ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �. ,
(651) 642-0800 TTY/MRS 1-800-627-3529 wwx.electricity.slate.mn.us
Describe -using the back of the white copy
GENERALFE
SERVICES I POWER SUPPLIES
0 to 400 Ampere a� $25
401 to 800 Am ere $50
Above 800 Am ere $75
CIRCUITS I FEEDERS
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ALARM, GOMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 �0 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Liphting Retrofit a(� $.25 per Fix�ure
Outdoor Lighting Standard
Traffic Sianal Standard (�
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns I Outline Li htin $5
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 Inspection Tri s $20
Investigative Fee
Reinspection Fee $20
TOTAL FEE ^��a(j(j
(minimum total fee is $20)
i HIS AREA FOR INSPECTOR USE ONIY
I hereby certi(y that I inspected the electrical installation described herein on the dates stated:
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5 cial Inspection @$30 per Hour exaieeo neamooNFO oATE
Special Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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17819129
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'���. Date: I Rou h-in Ins ection Re uired?
. ., g p q ❑ Yes �] No I. Inspection Other Than Rough-In: [�Ready Now ❑ Will Call
I! �' � t,���� You must call the inspector when ready! Date Ready _ I
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I certiTy that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Ske S eet Address � City � � � � � _ � � � � � �
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I, Townshi I Section ! Range I Fire No. i County
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� Owner/Occupant Name � ~ Please Provide Two-(2) Phone Numbers Induding Area Code
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Elecirical Utility � E el ctrical Utility Address
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'�� Contractor / Company Name � - 1 � � � Conhactor License Number Master Electrician or Power Limited Technician
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IrMaihng Address (C+ontractor, Coqmpany or Owner Performing Installation)
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Authorized Signature (Contractor or Owner Performing Installation) � Please Provide Two (2) Phone Numbers Including Area Code
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INSTRUCTIONS ON BACK OF YELLOW C07Y BOARD OF ELECTRIGTV COPV � Fa_nnnn�n_�s n� �nne