P - 77149r., REQUEST FOR ELECTRICAL INSPECTIONr ��
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� �� 2 9� 8� 3 �z, Minnesota Board of Electricity �-.-
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�� 3 (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the back of the white y i necessary - the work covered by this request:
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GENERAL FEES Outdoor L' htin Standard $1
SERVICES / POWER SUPPLIES Traffic Sianal Standard C� $5
Above 800 Am ere a$75
IRCUITS / FEEDERS
0 to 200 Am re $5 �
Above 200 Am re $1
ALARM, COMMUNICATION, REMOTE CANTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus $.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units @$50 Per Unit
Each Addftional Unit @ $25
OTHER ADDITIONAL
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irriaation Boom Ca1840
�eciai Inspection @ $30 per Hour
�ecial Inspection @ $.31 per Mile
INSTALLATION MAY I
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19298538
Transformers over t0 KVA $ 20
Transfortner I Power Su I for Si ns I Outline Li htin $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
Additional Ins ion Tri s $20
Invesii ative Fee
Reinspection Fee $20
TOTALFEE
(minimum total fee is $20) Q�
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I hereby certify that I inspeded the electrical installation desaibed herein on the dates state.d:
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IF NOT COMPLETED WITHIN 12 MONTHS ____�
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�uace: Rou h-in Ins
g pection Required? ❑ Yes o Inspection Ofher Than Rough-In: � Ready Now Will Call
t� '���� You must call the inspector when ready! Date Ready:
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site SVeet Address ��y
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Township Section Rang Fire No. County�
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erlOccupant Name Please Provide Two (2) Phone Numbers Induding Area Code
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13562 Central Ave
Address(Cont n
763-757-6202
i nature (C,entre or � P rtnin
ise Number Master ElecVician or PrnHer Limited l
I'--7 � j License Number
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Please Pro�ride Two (2) Phone Numbers Including Area
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