P - 77417REQUEST FOR ELECTRICAL INSPECTION
I � _ n � � C) �.A�e9ele-B�3�i.of Electricity ��(,S_Q�J(�/�
J Q � az,l n��ty Avenue Suite S-128, Saint Paul, Minnesota 55104
(b�"Jfj�'/MRS 1-800-627-3529 www.electricity.st�i�
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GENERAL fEES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES ,, , � ^ Traffic Sianal Standard nn $5
Above 800 Am ere $75
CIRCUITS / FEEDERS
0 to 200 Am ere $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Li h6n Retrofit @$.25 per Fi#ure
Center Pivot Irriaation Boom (� $40
Special Inspection $30 per Hour
Special Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCOI
I IIII N 1!I II II I I! I I I I I!!! II I I I II I I I II II) �� I�
1893929`3
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 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
Additional Insoection Trios la� $20
TOTALFEE
fee is $201
I hereby cedify that I inspected the electrical installation descnbed herein on the dates stated: �
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IF NOT COMPLETED WITHIN 12 MONTHS I
°` Rough-in Inspection Required? ❑ Yes ��plo Inspection Other Than Rough-In: ❑ Ready Now�Jp�ill Call
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You must call the inspector when ready! Date Ready:
I certify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Sit��ddress � Cih..—_ - c �
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Township Section Ran e '~�'L,~ �
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Owner/Occupant Name � Please Provide Two (2) Phone Numbers Including Area Code
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nnai�g Haa��contra r, company or Owner Perfortni Install�) - � �.- l E
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A r' Signature ( trado Owner Performing Ilation) Please Provide Two (2) Ph
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INSTRUCTIONS ON BACK OF YELLOW COPY BOARD OF ELECTRICITY COPY
or
> Including Area Code
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