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P - 77058, REQUEST FOR ELECTRICAL INSPECTION �"� 1� V V 1- 3 9 5 0 Minnesota Board of Electricity � p�, 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 � i. (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us �� Describe -using the back of the white copy if necessary - the work covered by this request: � ?r� f� ��' i�c� � `1�l GENERAL FEES Outdoor Lighting Standard $1 SERVICES / POWER SUPPLIES Traffic Signal Standard @$5 0 to 400 Ampere $25 , Supplemental Fee $20 401 to 800 Am re $50 Transformers u to 10 KVA $10 Above 800 Ampere $75 Transformers over 10 KVA $ 20 CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin $5 0 to 200 Am ere $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT Above 200 Am ere $10 Includes the Service and/or Power Supply up to 500 Amperes, All ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80 CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s $20 Each System Device or Ap aratus $.50 Investigative 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) �(� Each Additional Unit @$25 Tws naen Foa wsPecroR use ori� OTHER ADDITIONAL FEES Llghting R2Yroft $.25 pef FixtufB I hereby certify that I inspeded ihe elecincal installation descnbed herein on ihe dales stated: Center Pivot Irriaation Boom (� $40 Roo�H �N onTe ara[e tsonam ms ec[ion m�zu ecial Inspection $30 pBf HOUf exa�eoinenNOOr+EO on� ecial Inspection @ $.31 per Mile INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS _ I . .. . II III I IIII II IIl II ill II I�I II III !� II) �� II) �I� CI� 1,887395^ Date: ��� O� Rough-in Inspection Required? ❑ Yes �o Inspection Other Than Rough-In: Reaiy Now ❑ W�Call /a � You must call the inspector when ready! Date Ready: /� t� Q�__ '�- I certify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at Job Site Str�t A�ss �� ` {o� � � � City / �� �_/I L./ /j � � � ui�7 '� rt, r Township S tion Range Fire No. County � � d h�� Owner/Occupant Name Please Provide Two (2) Phone Numbers Including Area Code J�,��e �� � ��� �- 5 c � � s� � �� q 7 �i Eledrical Utility Electrical Utility Address �� e..e. L �'r � �S rN�� ���c .r2�P� Co trac�mpany Name Contrector License Number Master Electncian or Power Limitetl Technician �j � � d / � � O �� License Number � /yc_ ailin Address (Contractor, Company or Owner Performing Inst Ilation � �� �_ _ LL/ ,� P�� / � 5r�o,R�� �I�rT ��_ � i�o Authorized S' ra or or wner rming Installation) , Plea e Provi e Two (2) Phone Numbers Including Area Code � � �I � ��' � ��� �� _ Z , �� nY !�I( t�C VCI (f RllARfl (IF FI Ff�TRIfITV ffIPV FF11M1f11A_t5 A 1 �fl(ld