P - 77546REQUEST FOR ELEGTRICAL INSPECTION
/� Q% Minnesota Board of Electricity �
1� 3 4 7�'t V 1 �82� University Avenue Sufte S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529
www.electricity.state.mn.us
Identify the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION Ed REPAIR l%� /'�`�' �p �'�"� /5 � �2`p�' ` 2 �' n � � 7` < < '«-'�
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GENERAL FEES Outdoor Li Min Standard �$1
SERVICES / POWER SUPPLIES TraHic Si nai Standard (� $5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 A. re �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su for S' ns / Outline Li htin �$5
0 to 200 Am re �$5 p ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re�$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$BO
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional In ion Tri s�$20
Each S stem Device or A aratus �$.50 Investi tive Fee
ADDITIONS TO THE GENERAL FEES Reins ' n Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE �
3 to �2 Units �$5o Per Unit (minimum total fee is $20) 0,
EaCh Add'It10�e1 Uflit �$25 FOR INSPECTOR USE ONLV �1
OTHER ADDITIONAL FEES � �� .._�
Li htin Retrofit �$.25 r Fixture
Center Pivot Irri ation Boom �$40
ManufacturCd Home Park Lots �$25 I her certity mat 1 in ed the electrical installafion described herein on tne dates stated:
Recreational Vehicle Park Sites �$5 P01�"'" DA1E
rate Bondin In 'on � $2o t/ + �'�-
S 'al I 'on � $30 r Hour """""s"ECi10N �_- � .1 o"TE
S'al In ion �$.31 r Mile %
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN,1d�MONTHS
POR OFFlCE USE ONLY �Z
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Olher Than Rough-In: ❑ Ready Now II
GI � You must call fhe inspector when ready! Date Ready:
I certiiy that I am the ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Sheet, Box, or Route o.) City Zip Code
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SeCtion Townshi anae Fire Ne. Cou .
Occupant Phone
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Power Supplier �- Addr s
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Electrical Contractor / Company Name Contractor License Number Master License Number
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Mai mg ddress (Contrador, Company or Owner Perfortni r Ins Ilation)� �� �
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Authorized Si n ractor, er Perfo ing Installation) Phone
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E BOARD OF ELECTpICRY COPY INSTAUCTIONS ON BACK OF YELLOW COPY