P - 76418��� REQUEST FOR ELECTRICAL 1NSPECTfON -�� ��
1� 9 7 7� 9 3 6� Minnesota Board of Electricity �- �
` 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �`
� (651)642-0800TTY/MRS 1-500-627-3529 www.electricity.state.mn.us �:�
Describe -us' g the back of the white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor i htin Standard @$1
SERVICES I POWER SUPPLIES Traffic Siqnal Standard na $5
CIRCUITS I FEEDERS
0 to 200 Am ere a$5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CANTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENER4L I
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Unfts @$50 Per Unit
Each Additional Unit (� $25
i Home Park Lots
Vehicle Park Site
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer / Power Supply for Sipns I Outline Lightinq $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Fee
TOTALFEE ^ �
tOtal fee iS $20) ocO -�
I inspeded the electrical installation descnbed herein on ihe dates stated:
Special Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECT�D IF NOT COMPLETED WITHIN 12 MONTHS
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Date: Rou h-in Ins
g pection Required? ❑ Yes Inspedion Other Than Rough-In: ❑ Ready Now all
3� /�� You must call the inspector when ready! Date Ready:
I certify that I am the ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work ai
Job Site Sheet Address Cdy
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Towns ip Section Range Fire No. County
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Owner/Occupant Name Please Provide Two (2) Phone Numbers Including Area Code
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Electrical Utitity . Electrical Utility Address
Contrad ompany Name �
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Mailing Address (Contrador, (
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� - contractor License Number Master Electrician or Power Limited Technici:
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or Owner Performing Installation)
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wDer erfortni InstallaGon) Please Provide Two (2) Phone Numbers Including Area Code
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