P - 76706REQUEST FOR ELECTRICAL INSPECTION `
1 � Q �_('� � � � /I �% Minnesota Board of Electricity ��w
�:� �� `t � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 `
(651) 642-0800 TTY/MRS 1-500-627-3529 www.electricity.stute.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
GEN L FEES Outdoor Li htin Standard $t
SE ES I POWER SUPPLIES Traffic Signal Standard $5
0 to 400 Ampere $25 (J 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 1 Outline Li htin $5
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dweliing Unft @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s $20
Each S Stem Device or A paratus $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE [.� '-�
3 to 12 Units @$50 Per Unit (minimum total fee is $20) f r
E2Ch Addili0f121 Unif @ $25 THISAREAFORINSPECTORIISEONLY
OTHER ADDITIONAL FEES
Li htin Retfofd @$.25 pCr FiXtufe I hereby certity that I inspected the elechical installatlon described herein on the dales staled:
Center Pivot Irri ation Boom $40 RWGMIN o"�
Manufactured Home Park Lots $25
Reaeational Vehicle Park Sites $5 FINAL INSPECTION opT�
Se arate Bondin Ins ction $20 /�`�
Special Inspection $30 per Hour E%PIREDIAfl4NDONED o
Special Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS ___ u
' '' ��p APR - 2��2001
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Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspeclion Other Than Rough-In: ❑ Ready Now ❑ Will Call
��'" �� You must call the inspector when ready! Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical wak at
Job S' e SVeet Address , � ��b'��
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To ship Section Range Fire No. County �
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Owner/ pant Name ease Provide Two (2) Numbers Including Area Code
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Electrical Utility E I Udlity Ad s
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Contrador / Company Name ConVador License Number Master Electrician or Power Limited Tecbnicia �
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Mailing Address (Contractor, Company or Owner Perfortning Installatlon)
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A S' ture (Co r or Owner Perfortning Installation) Please Pro ' e Two (2) Phone Numbers InGuding Area Co( �
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