P - 76441REQUEST FOR ELECTRICAL INSPECTION �
2� 0 3�"� (� 7 0 � Minnesota Board of Electricity � s
° 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �`'
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us ?;�i�
Describe •using the back of the white copy if necessary - the work covered by this request:
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SERVICES I POWER SUPALIES
0 to 400 Amper� $25
401 to 80 Am ere $50
Above 800 Am ere $75
CIRCUITS / FEEDERS
0 to 200 Am ere $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Unfls @$50 Per Unit
Each Additional Unit na $25
Center Pivot Irrigation Boom �
Manufactured Home Park Lots
Recreational Vehicle Park Site
Special Inspection $.31 per Mile
THIS INSTALLATION MAY BE
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Outdoor Lightin Standard $1
Traffc Si nal Standard a$5
Su plemental Fee $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns I Outline Li htin $5
ONE 8 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 C� $20
TOTAL PE j I �X�'/ G> >" I
total fee is $20 �
I hereby certi(y that I inspeded the elecVical inslallation desaibed herein on ihe dafes stated:
ROUGH IN DAIE
FIN4LINSPELiION Dp}E
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NECTED IF NOT COMPLETED WITHIN 12 MONTHS
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°` Rough-in Inspection Required?.�e �No Inspection Other Than Rough-In: � Ready Now�Nill Call
�v— /�� You must call the inspector when ready! Date Ready:
I certify that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby req st inspection of the electrical work at:
Job Site Street Address ity
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Name
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Mailing Address (Contrador, Compan or
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Authorized tu (ConVactor or Owi
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License Number aster Electrician or Power Limited
License Number
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Ple se Prov�� e Two (2) Phone Numbers InGuding Are
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