P - 77579s ��,
REQUEST FOR ELECTRICAL INSPECTION �� �,
��s� ��,� �� 0 4 � Minnesota Board of Electricity K '� �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
. (651) 642-0800 TTYIMRS - - 27-3529 www.electricity.state.mn.us .;��
Describe -using the back of th white copy,rf nece - the work covered by this requ . � b -�`Q a
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GENERAL FEES Outdoor Lightin Standard @$1
SERVICES I POWER SUPPLIES Traffic Signal Standard $5
0 to 400 Ampere $25 Sup lemental Fee @$20
401 to 800 Am ere $50 Transformers u to 10 KVA $10
Above 800 Am ere $75 Transformers over 10 KVA $ 20
IRCUI S I FEED,ERS Transformer I Power Su I for S' ns I Outline L' htin $5
0 to 200 Am ere $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
` Above 200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional ins ion Tri s $20
Each S stem Device or Apparatus $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE � '—
3 to 12 Units @$50 Per Unit (minimum total fee is $20) • c, %
EachAdditionalUnit@$25 TwsnaEnFOainsrECTOause �r
OTHER ADDITIONAL FEES
Li hting Retfofil $.25 pBf Fixtur0 I hereby certi(y that I inspecled the elechical installation described her in on the dates stated:
Center Pivot Irri ation Boom @$40 R01GH �" oATE
Manufadured Home Park Lots $25
Recreational Vehicle Park Sites $5 `� �"�c/T�°" � �p�
Se arate Bondin Ins ion $20 ` �� � Z�— �
Special Inspection $30 per Hour �`P1RE°'"�""D0NE0 ��
S ial Inspection @$.31 per Mife
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS____
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L8208041
Date: Rough-in Inspection Required? ❑ Yes 7w�o Inspectian Other T Rough � ow ❑ Will Call
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� You must call the inspector wheo ready! Date Ready: ��� �
I certify that I am t ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Sfte Street Address ��Y ' ,
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Township Section Range Fire No. County
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Owner/ ccupant Name Please Provide Two (2) Phone Numbers�ding Area Code
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ri UIRy Electncal Utility Address - °
Con r/ Company Name - Contractpr�L�i nse Number � ter Electrician or Power Limited Technician
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Mailin ddress (Contractor, Co panypr Owner erforming Installati ) /�
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Authorized Si ature (Con c� r or Owner Performing In allation) Please Pr�ovi/d�e� Two (2) Phone Numbers Induding Area Code
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�ucreu�nnus nu aer. nc vci i nw covv 80ARD OF ELECTRICITY COPY _ EB-00001A-15 8.1. 2004