P - 77114REQUEST FOR ELECTRICAL INSPECTION T"��
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❑ Minnesota Board of Electricit �- �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �: �.�
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(651)642-0800TTY/MRS 1-800-627-3529 wwrv.eleclricity.state.mn.us .�s
Describe -using the back of the white copy if necessary - he work covered by this request:
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GENERAL FEES Outdoor iahtina Standard an $1
0 to 400 Ar
401 to 800
Above 800
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or A paratus a$.50
ADDITIONS TO THE GENERAL
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
FEES
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer / Power Supply for Signs I Outline Lighting @$5
ONE & 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
TOTAL FEE
total fee is $20)
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I hereby certiN that I inspected the electrical installation described herein on the dates stated:
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5 F�NA��NSPECnoN
Se arate Bondin Ins ction $20 �
Special Inspection @$30 per Hour exP�REO�nanNOc
Special Inspection $.31 er �1ile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF
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L9037290
COMPLETED WITHIN 12 MONTHS _ _�
uate: Rough-in Inspection Required? ❑ Yes �No Inspection Other Than Rough-In: ❑ Ready Now � Wiil Call
� f/'�//'w You must call the inspector when ready! Date Ready: �� �%(l �. aS
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I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspedion of the electrical work at:
Job Site Street Address
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Township Section Range Fire No. County
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Owner/Occupant Name Please Provide Two (2) Phone Numbers InGuding Area Code
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ConVactar / Company Name
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Mailing Address (Contrector, Company or
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Authorized Signature (Contractor or Owi
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