P - 76572REQUEST FOR ELECTRICAL INSPECTION ��y
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I 1��� O- 5 5 5 0 Minnesota Board of Electricity K �,
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �.
(651) 642-OS00 TTYIMRS 1-800-627-3529 w-K�w.electriciry.stute.mn.us ���
Desc�be -using the back of the white copy if necessary - the work covered by t' reque �
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GENERAL FEES Outdoor Liohtina Standard (� $1
0 to 400 Ampere a$25
401 to 800 Am ere $50
Above 800 Am ere $75
CIRCUITS / FEEDERS
0 to 200 Am ere $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit an �25
OTHER ADDITIONAL FEES
Lighting Retrofit @ $.25 per Fixture
Center Pivot Imgation Boom @ $40
Manufactured Home Park Lots @ $25
Recreational Vehicle Park Sites la� 35
Specfal Inspection a$30 per Hour
Special Ins ction $.31 per Mile
THIS INSTALLATION MAY BE ORDERED
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18805556
Supplemental Fee $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / Outline Li htin $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
Additional Inspection Trips @ $20
Investigative Fee
TOTALFEE c�
total fee is $20) � � � .� v
I hereby certify that I inspeded the electncal insWllation descnbed herein on the dates stated: �
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COMPLETED WITHIN 12
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O1 Rough-in Inspection Required? ❑ Yes [�Vo i Inspection Other Than Rough-In: y Ready Now � Will Call
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You must call the inspector when ready! Date Ready:
I certiiy that I am the �, LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Street Address
City
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Township Section Range Fire No. Count
Owner/Occup� nt Name / Please Provide Two (2) Pho�e Numb�Incl�Area Code
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Electrical Utility � Electrical Utility Address
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Contractor / Company Name / Contractor License Number Maste Electricia r Power Limited Technician
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Mailing Address (ConVactor, Company or Owner Pertorming Installation)
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Author' i nat Contr ct or Ow er Performing Installation) Please Provide Two (2) Phone Numbers Including Area Code
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INST C NS ON BACK YELLO Y BOARD OF ELECTRICITY COPY Fa_nnmm�_�s n� �nnn