P - 76363REQUEST FOR ELECTRICAL INSPECTION ��`��
2 s b�� ��'� 8� Minnesota Board of Electricity 4
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us %�
Describe -using the back of the white copy if ne�cessary - the work covered by this request:
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GENERAL FEES Outdoor Lightin Standard @$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Ampere $25 1/ Supplemental Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am ere $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin $5
0 to 200 Am ere $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or A aratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
L' htin Retrofit $25 per Fixture
Center Pivot Irriaation Boom f�a $40
ispection @ $.31 per Mile
ALLATION MAY I
Fee � $20
TOTAL FEE � � � � ��
iimum total fee is $201
I insoeded ihe electrical installation described herein on the dates slated: �
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IF NOT COMPLETED WITHIN 12 MONTHS________�
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IIII IIIII Ilill II III Ill�i Ill�i IIIII IINI ��I I�I( �� ����� -�
?0672689
Date: � Rou h-in Ins ection Re uired?
�_���� '� g p q ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now Will Call
J 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 work at:
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� Mailing Address
Perfortning Installation)
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Please Provide T o(2) Phone Numbers Including Area Code
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imbers InGuding Area Cpde
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