P - 76361REQUEST FOR ELECTRICAL INSPECTION - �`�
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2° Q 9�"�' � cJ 1� Minnesota Board of Electricity k;
__ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
(651) 642-0800 TTY/MRS 1-800-627-3529 wwr��.e[ectricity.state.mn. �
Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Lighting Standard $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 AmpEfe U(� $25 SIIfI[IIP.RIP.f1TAI FP.P. n AiO
Above 200 Am ere a$t0
ALARM, COMMUNICATION, REMOTE CANTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDI'
Lighting Retrofit @ $.25 per Fix
Center Pivot Irrigation Boom @
Manufactured Home Park Lots i
Recreational Vehicle Park Sites
THIS INSTALLATION MAY BE ORDERED
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Transformers over 10 KVA $ 20
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
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inslallation described herein on the dafes stated:
�TE NOT COMPLETED WITHIN 12 MONTHS
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Date: Rough-in Inspection Required? Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now Will Call
��("/ 7 You must call the inspector whe ready! Date Ready:
I cert'rfy that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electricai work at
Job Site Street Address City
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Township Section Range Fire No. County
OwnedOccupant Name Please Provide Two (2) Phone Numbe � ding Area Code
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Electrical Utility Eledrical Utilrty Address
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Mailing Address (
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c:ontractor ucense Number Master Electrician or Power Limited Technicia
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any or Owner Performi g Installation)
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or Owne e rtni s ' n) , Please Provide Two (2) Phone Numbers InGuding Area Code
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i OPY BOARD OF ELECTRICITV COPY aa_nnnm e_.c o� on