P - 76584� REQUEST FOR ELECTRICAL INSPECTION
I �,— 9 3 4� O 1� ,'°:�, Minnesota Board of Electricity �-,� :
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us �" "
Describe -using the back of�he white copy if _ ary - the work covered by this request:
� GENERALFEES
SERVICES I POWER SUPPLIES
Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CANTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus $.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 hting Retrofil $.25 per Fixture
Center Pivot Irriaation Boom lo� $40
Special Inspection �, $30 per Hour
S'al Ins ion a.31 r Mile
THIS INSTALLATION MAY BE ORDERED
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19340181
Standard
Traffic
� Transformers over 10 KVA @$ 20
� Transformer / Power Supply for Signs I Outline Lightinq $5
ONE & 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 Insoection Trios C� $20
TOTAL FEE � �}J'1 � � O
total fee is $20) ��(J
thal I inspecled Ne elecVical installation desaibed herein on fhe dates stated: �
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IF NOT COMPLETED WITHIN 12 MONTF
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Rough-in Inspection Requi�ed? ❑Yes � Inspection Other Th Roug dy Now ❑Will Call
You must call the inspedor when ready! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Stte �d l � � � . � /�/Ol�
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INSTRUCTIONS ON BACK O: YELLOW COPY
Please Provide Two (2) Phone Numbers
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Address
� Gontractor llcense Number Master Electrician or Power Limked Technician
� � License Number
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s I ti Please Provide Two (2) P ne Numbers Including Area Code
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BOARD OF ELECTRICIN COPV cannm� e i c e. onn.