P - 76395REQUEST FOR ELECTRICAL INSPECTION ��F
2� 0 9�� 7 g 6� Minnesota Board of Electricity �-
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricrty.state.mn.us ;��'
Describe -using the back of the y!hite�py if necp,ssa the work covered by this requ�t: „
� GeNERALFEES`
SERVICES / POWER SUPPLIES
0 to 400 Ampere $25
401 to 800 Am re $50
Above 800 Am ere $75
IRCUITS / FEEDERS
0 to 200 Am ere $5 .�a
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A paratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Li htin Retrofit @$.25 per Fixture
Center Pivot Irri ation Boom $40
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5
Se arate Bondin Ins ection $20
Special Inspection @ $30 per Hour
S ecial Ins ection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DI
i IIII II III II (�I II III II III II III II (II II III �� I Illi
20927968
Supplemental Fee $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / Outline Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ection Tri s $20
Investi ative Fee
Reins ection Fee $20
TOTALFEE
Iminimum total fee is $201 �
I herebv certiN that I insoeded the electrical installation described herein on the dates stated: �
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E%PIREDIA&4NOONED �ATE
JECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Date: Rough-in Inspection Required? ❑ Yes �,(Jo Inspection Other Than Rough- Re No ill all
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You must call the inspector when ready! Date Ready:
I certify that I a LICENS NTRACTOR ❑ COMPANY ❑ OWNER and hereby reque inspectionrof the electrical work at:
Jo��t ess City
Township Section Range Fire No. Cou ty
O /Occupant Name �� � Please Provide Two ) P Numbers Including Cod
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tri I Utility Eiectrical Utility Address
Contr or Company Name �/�� i �� Conirador Lice � Numt�gc-� Master Electrician or Power LimRed Technician
�_ � �1'1 / � v i� License Number
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Mailing dd ss Contrador, C pany or e i g I Ilation) /_
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Autho igna n ct r or Owner Perfo � g Installation) Please Provide wo ) n Numbers Including Area Code
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