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 �
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(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: �
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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 _
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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�__
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I certify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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Township S tion Range Fire No. County
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Owner/Occupant Name Please Provide Two (2) Phone Numbers Including Area Code
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Eledrical Utility Electrical Utility Address ��
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Co trac�mpany Name Contrector License Number Master Electncian or Power Limitetl Technician
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ailin Address (Contractor, Company or Owner Performing Inst Ilation � �� �_ _ LL/ ,� P�� /
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Authorized S' ra or or wner rming Installation) , Plea e Provi e Two (2) Phone Numbers Including Area Code
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