P - 79497REQUEST FOR ELECTRICAL INSPECTION
P� Minnesota Board of Electricity ``°�
�� 2 7 9��� O ° 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
Identity the work covered by this request: �Cu2rj�� ��(� '(-0�Q.
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Tra�c Si nal Standard �$5
0 to 400 Amoere �$25 Su lemental Fee �$20
Above 8� Ampere �
�UITS / FEEDERS
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apparatus �$.50
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Center Pivot Irrigation Boom � $
Manufaciured Home Park Lots �
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Cirwits and Two Inspection Trips Each Dwellin Unit �$8C
Additional Ins ection Tri s�$20
Investi ative Fee
Reins�ection Fee � $20
total fee is
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that I insceded the electrical installation
al Ins ection � $30 r Hour " — — - - """""'"""""" """
al Inspection �$.31 per Mile Z-,�- a3
S INSTALLATION MAY BE ORDERED DISCONNECTED IF T COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) City / Zip Code
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County �
,�no
Phone
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Power Supplier � " Address
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Electrical Contractor / Company Name Contractor License Number Master License Number
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Mailing Address (CoMractor, Company or Owner Pertortning Installation)
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Authorized Signature (Contractor, Comp or Owner Perfortning Installation Phone
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E&OOOOtA-13 7/1/2000 BOARD OF ELEC7AICITY COPY INSTFiUCTIONS ON BACK OF YELLOW COPY