P - 76557'1-781-903 8❑
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GENERALFEES
SERVICES / POWER SUPPLIES
0 to 400 Ampere @ $25
401 to 800 Ampere (� $50
REQUEST FOR ELECTRICAL INSPECTION �
Minnesota Board of Electricity rr:
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 x�x�ia•.eleciricilv.state.mn.us
�- the work overed by �hi �e st�
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Outdoor Liqhtinq Standard (� $1
CIRCUITS / FEEDERS
0 to 200 Am ere $5 ��C�—�
Abflve 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units (c� $50 Per Unit
FEES
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irrigation Boom @ $4(
Manufactured Home Park Lots @ $
Recreational Vehicle Park Sites (a�
Supplemental Fee @ $20
Transformers up to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns I Outline Li htin $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
Fee
Fee
IUTALhtt 4����(J
total fee is $20)
I hereby certify that I inspected the electrical installation descnbed herein on the dates stated:
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Special Inspection @$30 per Hour exaiae�, nanNnor�e� oATE
S cial Inspection @$.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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"`' j Rough-in Inspection Required? ❑Yes �.] No �'�. Inspection Other Than Rough-In: [�Ready Now ❑Will Call
�' f`" �f ��� I You must call the inspector when ready! I Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job SHe Street Address i City _., �
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�� � o��ip ', section Range '�, Fire No. '�, County -
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Owner/Occu ant Name Please�Provide Two (2) Phone Numbers Including
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� Eleclrical Utility , Electrical Utility Address �
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. Contractor / Company Name , Contractor License Number Master Electrician or Power Lim
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Mailing Address (Contractor, Company or Owner Performing Installation) �
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Autho�ized Signature (Contractor or Owner Performing Installation) -�- �I Please Provide Two (2) Phone Numbers Including
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Technician i
INSTRUCTIONS ON�/"�.;:,��ELLOW COPV BOARD OF ELECTRICITY COPV pa-nnnma.�s e� �nne