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REQUEST FOR ELECTRICAL INSPECTION ��.��.�� �
1����� 0 4 8� Minnesota Board of Electricity �(� �— Q�� � ,,,�s�
1821 University Avenue Suite S-128, Sa t aul, Minnesota 5 104 _�. .
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us .,.;!��
Describe ing th back of the white copy if necessary - the work vered by this request:
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GENERAL FEES Outdoor Lightin Standard $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am ere $25 Supplemental Fee $20
401 to 800 Am ere $50 Transformers u to 10 KVA $10
Above 800 Amoere al� $75 Transformers over 10 KVA (� $ 20
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit $25 per FiMure
Center Pivot Irriaation Boom na $40
� Transformer / Power Supply for Signs / Outline Lighting @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
total fee is
I herebv cert'rfy Nat I inspecled the eledripl installation desaibed herein on Me dates stated: �
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Special ins ion $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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18510487
Date: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-Irc eady Now ❑ Will Call
/ j0� You must call the inspector when ready! Date Ready:
I certify that I am the �CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work ak
Job S'te Street Address City
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Township Sedion Range Fire No. County
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Owne ccupant Name Please Provide Two (2) Phone Numbers Including Area Code
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Electrical Utility Electrical Utility Address
Contr Ctor Licens2 Numb2r Master EleCtncian or Power Limded TecY
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tion) Please Pr vide Two (2) Phone Numbers Including Area Co
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�ARD OF ELECTRICITY COPY EB-00001A-15 F