P - 77329REQUEST FOR ELECTRIC/,�L INSPECTION "�'''�a�,
1-8_6�-208 7 ���: �
❑ Minnesota Board of Electricity �`��-���L�G �; ,�,
1821 University Avenue Suite S-128, Saint Paul, mnesot �q�� �
(651) 642-0800 TTY/MRS 1-800-627-3529 www.e[ectriciry.stale.mn.us ?;��
Describe -using the back of the white copy if necessary - the work covered by this request:
GENERAL FEES Outdoor Li htin Standard $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Amcere aC2 $25 Suo�lemental Fee la� $20
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Transformers over 10 KVA $ 20
Transfortner I Power Supply for Signs I Outline Lighting @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two InspecGon Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investiqative Fee
totai fee is $20) I � d`S�
I hereby certiry that I inspected the electrical installation descnbed herein on the dates slated:
ed Home Park Lots $25
al Vehicle Park Sites $5 FIW1L INSPELTION
ondin Ins ection $20
JQC��O� $30perHour EXPIREDIABPNDONED
�ection $.31 per Mile
►LLATION MAY BE ORDERED DISCONNECTED_IF NOT COMPLETED WITF
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Date: Rough-in Inspection Required? ❑Yes �o Inspedion OtherThan Rough-In:�ady Now �Will Call
q— \Q � �� You must call the inspector when ready! Date Ready:
I certify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Address Cii.�
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-7- Section � Range FireNo. County
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ie Please Provide Two (2) Phone Numbers I
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Electricat Uti rty Address
Name Contrador License Number Master Eledrician or P
� License Number
:ractor, ompany or Owner Pe orming Installation)
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ontra o Owner rf in Please Provide Two (2) Phone Numbers I
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F YELLOW C BO OF ELECT COPY
Technician I