P - 77373REQUEST FOR ELECTRICAL INSPECT ON ��
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� � ❑ Minnesota Board of Electricity p�QQS — Q/��� ,r-
` 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 -
' (651) 642-0800 TTY/MRS 1-800-627-3529 ivtiti�N�.electricity.slate.mn.us
Descnbe -using the back of the white copy if necessary - the work covered by this request:
EXCEL kh1E�iGY SAVEF: ' S SGJ I TrH
GENERAL FEES Outdoor Liqhtinq Standard (� $1
SERVICES I POWER SUPPLIES
0 to 400 Ampere @ $25
401 to 800 Am ere $50
Above 800 Am ere $75
CIRCUITS / FEEDERS
0 to 200 Am re $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, S
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEI
MllLTIFAMILY 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 IrriQation Boom (� $40
Supplemental Fee @ $20
Transformers up to 10 KVA @$10
Transformers over 10 KVA a$ 20
Transformer I Power Su I for Si ns I Outline Li htin $5
ONE 8 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
TOTALFEE
total fee is $20) �' ���
that I inspected the electncal installation descnbed herein on the dates stated:
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Special Ins ection @$.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
IIII II Ia II I� Ii III II III N III II III II Nl II III I IIII
17813643
�,, ��f `(��Q Cj � Rough-in Inspection Required? ❑Yes � No �I Inspection Other Than Rough-In: [�Ready Now ❑ Will Call
___ _1You must call the inspector when ready! __ II Date Ready: _
— —
I I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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Section
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Nlease F'rovitle Two (2) Phone Numbers Including Area Code
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,� u���y i ciecincai unuiy Haaress
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i�Q4S�1���7�qaq!(��[n�c Co�.����l..Z�� '�Contractor�nsejV�{rqp�.t IMasterElectricianor
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FMailing Address (Contractor, Company or Owner Performing Installation) I �- —�
�' �'304 TERF�ITOf,I�I_ ROAD, SAINT F'AUL, hfhl 55114
If Authorized Sisnature (Contrector or Owner Performing Installation) � -� ?please Provide Two (2 Phone Number
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wsrrtucrinuc nu wer.K nc vci � nw cnov Anno� �� �� �,-TO���T� ��o�
� Including Area Code
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