P - 77525'7 REQUEST FOR ELECTRICAL INSPECTION �.
1� 1��- 9 3 2 1 Minnesota Board of Electricity `�e`` `�'
❑ �-.
1821 University Avenue Suite S-128, Saint Paui, Minnesota 55104 �. .
(651) 642-0800 TTY/MRS 1-800-627-3529 iawx.electricity "
. state. mn. us
Describe -using the back of the white copy if np,�p� S�(µ.. the work,c�veted by lbis Sqy�uest; _. {, �.-
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J GENERAL FEES Outdoor Li hting Standard @$1
SERVIC�S I POWER SUPPLIES Traffic Signal Standard @$5
Q to 400 Ampere Q$25 Supplemental Fee (� $20
401 to 800 Am ere $50
Above 800 Ampere $75
CIRCUfT� I FEEDERS
0 to 200 Ampere $5
� Above 200 Ampere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SI
CIRGUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEE
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
U htin Retrofit @$.25 per Fixture
Center Pivot Irri ation Boom $40
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites (� $5
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns I Outline Li htin $5
ONE 8 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 Ins ection Tri s $20
Investigative Fee
Reinspection Fee @ $20
TOTALFEE ;�i_?,;:�';?
(minimum total fee is $20)
THIS AREA FOR INSPECiOft USE ONLY
I hereby certify that I inspected the electrical installation descnbed herein on the dates stated:
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Spec�al Inspection @ $.31 per Mile
TH1S IAISTA�LATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12_MONTHS
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- vaSe. � Rough-in Inspection Required? ❑ Yes
��� i.; f,..,,� ,� � il •�] No . Inspection OtherThan Rough-In: [�Ready Now ❑Will Call
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�. ; You must call the inspector when ready! � Date Ready:
I certify that I am the C`] LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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IrOwner/Occupant Narne � Please Provide Two (2) Phone N
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�, EleCtrica! Utility � � i E�ectrical Utility Address
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i Coniractor / Company Name - � I�- --� ��. Contractor License Number ' Master Electrician or Power Li
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I Mvlu�g Address�Conlrector Company or Owqner Performinyc�1 In rtallaliont) -- �� —� �
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Ayth rized S' nature (Conhactor or Owner Performing Installation) - �. please Provide�Two (2) Phone�Ni
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fN6TRyCT1ONS ON BACK OF YELLOW COPV Rnnan nF ci F-r.roi rnov � �
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Area Code