P - 77231' REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity � _
1- 3 4 7- 4 4 4 1821 Universiry Avenue Suite S-128, Saint Paul, Nlinnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 \ -
www. electrici ty. state. mn. us
Identify the work covered by this request:
❑NEW REMODEL ❑ADDITION ❑REPAIR L'! 4 / "I �` �''6 "�--�
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Tra�c Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 7ransformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su for Si ns / OuUine Li htin �$5
0 to 200 Am re�$5 / — ONE & 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 Dwellin Unit �$8f
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Trios �$20 ,
Each S em Device or ratus �$.50 Inves6 tive Fee
ADDITIONS TO THE GENERAL FEES Reins 'on Fee �
MULTIFAMILY DWELLIN�S PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25 fOfl1N�0T0R "� °NLY
OTHER ADDITIONAL FEES
Li htin Rehofit �$25 r Fixture -�
Center Pivot Irri tion Boom �$40
Manufactured Home Park Lots �$25 I hereb certiry mat I inspecte
Recreational Vehicle Park Sites �$5 R01GH �'
Se te Bondi Ins ion �$20
Soecial Insoection � $30 cer Hour """"'�`�"0N
total fee is
described herein on the dates stated:
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IF NOT COMPLETED WITHIN 18
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
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You must call the inspector when readyl Date Ready:
I certity That I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �f OWNER and hereby request inspection of U�e electrical work at:
Job Address (Street, Box, or Route No.) Ciry Zip Code
7�1� 7/'� �t.a ,z��, f,e�.a � ��i, /YJ�✓. SS5�3 Z
Section Township Range Fire No. County
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Occupant Phone
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Power Supplier Address /-+
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Electrical Contrador / Compeny Name Contrador License Number Master License Number
Mailing Address (Conhador, Company or Owner Perfortning Installation)
Authorized Signature (Contractor, C or Owner PeAorming Installation) Phone
_ ., . . ._. _ .. . --___
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•. EB-00001A-13 7/1/2000 BOMD OF ELECipICITY COPY INSTRUCTIONS ON BACK OF YEILOW COPV