P - 77102' REQUEST FOR ELECTRICAL INSPECTION �
1r— 910 � O� O � Minnesota Board of Electricity - � "
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
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(651)642-0800TTY/MRS1-800-627-3529wHnv.electricity.state.mn.us �
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Describe -�usin the back of the whit copy if necessary - the work covered by t's request: � '� �
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GENERAL FEES Outdoor Lightin Standard @$1
SERVICES I POWER SUPPLIES Traffic Signal Standard $5
0 to 400 Ampere $25 Supplemental Fee $20
401 to 800 Am ere $50 Transformers u to 10 KVA $10
Above 800 Am ere $75 Transformers over 10 KVA $ 20
CIRCUITS I FEEDERS Transformer / Power Su I for Si ns / Outline Li htin $5
0 to 200 Am re $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwefling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Insoeclion Trios f�a $20
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS fPER UNITI
Center Pivot Imgation Boom @
Manufactured Home Park Lots
Recreational Vehicle Park Site:
THIS INSTALLATION MAY BE ORDERED
IIIII IIIII IIIII Illli IIlI IIII II�II IIIII ��I I��
191�0585
TOTALFEE
total fee is $201
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that I inspeded the electrical installation descnbed herein on the dates stated:
APLETED WITHIN 12 MONTHS
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uace: Rough-in Inspection Required? ❑Yes �No Inspedion Other Than Rough-In: �eady Now ❑ Will Cali
l(i �� � �Q j You must call the inspector when ready! Date Ready:
I ceR'rfy that I am the LiCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby r ion of the electrical work at:
Job Site Street Address
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Township Section Range Fire No. County
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�t����Y
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/ Company Name
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dress (Cont ador, Company or Owi
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)NS BACK OF YELLOW COPY
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Please Provide Two (2) Phone Numbers Including Area Code
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Utilky Address
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OF ELECTRIGTY COPY
mascer e�ecmGan or
License Number
7wo (2)
Technician I
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