P - 764681 7 8 7 918 O REQUEST FOR ELECTRICAL INSPECTION �
� � Minnesota Board of Electricity ;i� \ �'
❑ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �: ,
� (651) 642-0800 TTY/MRS 1-800-627-3529 wH�ti��.electricity.slate.mn.z�s
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FEES
0 to 400
tWt, COMMUNICATION, REMOTE CONTROL, SIGNALING
UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Sysiem Device or Apparatus @$.50
�" ADDITIONS TO THE GENERAL FEES
fIFAMIIY DWELLINGS PER UNIT
3 to 12 Units Q$50 Per Unit
Each Addittonal Unit (� $25
Boom �
ark Lots
Outdoor Lighting Stanc
Traffic Signal Standard
Supplemental Fee @ $
Transformers up to 10
Transformers over 10 i
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Ciraits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investiqative Fee
(minimum total fee is
the electrical installation descnbed herein on ihe dates stated:
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S aal Ins ction @$.31 per Mile
Tti18 MISTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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���� ''I Rough-in Inspection Required? ❑Yes ?❑ No ; Inspection Other Than Rough-In: [�Ready Now ❑Will Call
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' You must call the inspector when ready! '� Date Ready:
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I certi(y that I am the L•i] LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER antl hereby request inspection of the electrical work at:
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wner(Occupant Name ��Please Provide Two (2) Phone Numbers Including Area Code
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'I Eiectrical UtiFty '', Electrical Utility Address
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�I Conttactor I Company Name �-�� � l'i Contractor License Number � Master Electrician or Power Limited Techni�
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, Mailing Address (Contractor, Company or Owner Performing Installation)
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I� qu+rthorized S' nature (Coniractor or Owner Performing Installation) � '� Please Provide Two (2) Phone Numbers Including Area Code
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