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P - 77652REQUEST FOR ELECTRIC L INSPECTIO ��'�3' � 1�� 8���'� 6 g g� Minnesota Board of Electricity �Q�S—/'��� r �� � ':p 1821 University Avenue Suite S-128, aint Paul, Minn`eso�a 5��4 �` (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us Des�ibe -using the back of the white copy if pecessary - the work covered by this request: � ��'�a� s�.e''v<�,t' C�'C��.S�� _ C�.z.,c� � � r�'t �✓/��'J'I � � GENERAL FEES Outdoor Lighting Standard $1 SERVICES / POWER SUPPLIES Traffic Signal Standard $5 0 to 400 Ampere $25 Su plemental Fee $20 401 to 800 Am re $50 Transformers u to 10 KVA $10 Above 800 Am re $7 Transformers over 10 KVA $ 20 CIRCUITS I FEEDERS Transformer I Power Su I for Si ns / Outline Li htin $5 0 to 200 Am re $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT Above 200 Am ere $10 Includes the Service andlor Power Supply up to 500 Amperes, All ALARM, COMMUNICATION, MOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80 CIRCUITS, CIRCUITS OF L S THAN 50 VOLTS . Additional Inscection Trios (� $20 Each System Device or ADDITIONS TO THE GENERAL F MULTIFAMILY DWELLINGS PER UNiT 3 to 12 Units @$50 Per Unit Each Addifional Unit C� S25 f Home Park Vehicle Park edal Inspection @$.31 per Mile � INSTALLATION MAY BE ORDERED i III�I IIIII IIIII IIIII IIIII I�III IIIII IIIII �� I� 18476895 TOTAL FEE total fee is $20) ,� j�, I inspected the elechical installa6on described herein on ihe dates stated: -1�� '"� IF NOT COMPLETED WITHIN 12 MONTHS � Rough-in Inspection Required? ❑Ye No Inspection Other Than Rough-In: ea w❑ Will Call ���i/ /s � l.� � You must call the inspector when ready! Date Ready: �C G� I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at Job Ske Street Addre _ ��y ��2�� ���721 "' � ►rZi �..1�� Township Section Range Fire No. CounN /\ , � i, `-- rical Utility Address i ��1 � �: I ����� , wide Two (2) Phone Numbers Including Area ��'. � �l \ / .K //�� �nx �vurnoer mas�er ciecmaan or ���-, _/ ( . ,�� ���� License Number � � ���- �any or wner Perfo g Ins allatio ) /� ,•� ., G�i/l � �%2�Gr�< :�1 '.�''� ,,S � or Owner Performing Installatlon) Please Provide Two (2) Phone Number � �; � Z) �t�2��a � � Z I COPY BOARD OF ELECTRICITY COPV Area