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P - 81563REQUEST FOR ELECTRICAL INSPECTION ' � Minnesota Board of Electricity �� �� 3�� 8�� �a 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 - � � (651) 642-OS00 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us " ' Identify the work covered by this request: �� �G EW ❑ REMODEL ❑ ADDITION ❑ REPAIR GENERAL FEES Outdoor Li htin Standard �$1 SERVICES / POWER SUPPLIES Tra�c Si nal Standard �$5 0 to 400 Am ere �$25 Su lemental Fee �$20 401 to 800 Am re �$50 Transformers u io 10 KVA �$10 Above 800 Am ere �$75 Transfortners over 10 KVA �$20 CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li hti �$5 0 to 200 Am ere �$5 l� �" ONE & TWO FAMILY DWELLINGS, EACH UNIT Above 200 Am ere �$10 Includes the Service andlor Power Suppty up to 500 Amperes, All ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$80 CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20 Each S stem Device or A aratus (� $.50 Investi ative Fee ADDITIONS TO THE GENERAL FEES Reinsoection Fee �$20 Each Additionai Unit � $25 OTHER ADDITIONAL FEES Manufactured Home Park Lots � Recreational Vehide Park Sites � Seoarate Bondina Insuection � $; FOR OFFICE USE WILY ( llllll lllll lllll Eflll IIIN 111� �Ifll IIII llll �4 i D 3 9 B z 2 Z' �4 total fee is $20) 6Z 4� that I insoecied the electrical installatlon I certify that I am the �ICENSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the eleCtrical work at: Job Address (Street, Box, or Route No.) Ciry � Zp Code � � O .J �► V Sec[ion Township R ge Fire No. Coun Occupant � �a.�- � PowerSupplier S A�� Address 1C Electrical Contractor / Company Name � l.� Mailing Address (Contractor, Company or Owner Performing Installation) 1 Y d" Il '��/�M� �"'�`�--n i w�l.�'/� Phone l� I i. ' Y 3�i- � License Number � �.3 6 � allation) Phone l�S�-sSa—�7�7 OF ELECTRICRY COPV INSTHUC710N3 ON BACK OF YELI.OW COPY