P - 77656REQUEST FOR ELECTRICAL INSPECTION �'���'���
1H-�3� 936 0 �W �
s �e ❑ Minnesota Board of Electricity s� �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �.
(651) 642-OS00 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us ���
Describe -using the back of the white copy if necessary - the work covered by this request:
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GfNERA� FEES Outdoor Liqhtinq Standard an $1
0 to 400 Ar
401 to 800
Above 800
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units kil $50 Per Unit
Center Pivot Irrigation Boom
Manufactured Home Park Lc
Special Ins ection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED D
Illll il III III� IIIII IIIlI II III Iilll IIIII �� I�
18399360
Transformers u to 10 KVA $10
Transfortners over 10 KVA @$ 20
Transformer / Power Supply for Signs / Outline Lightin $5
ONE 8 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
Fee
TOTALFEE
total fee is $201 �Qr
1 hereby certify that I inspected Ne electrical installation described herein on the dates stated: �
IF NOT COMPLETED WITHIN
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�ace: Rough-in Inspection Required? ❑ Yes f�NO Inspection Other Than Rou h-In�ead Now
j�\ g y ❑Will Call
j Q �f 6 y You must cali 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:
JobSi SVeetAddre City
�47 � /lJ ' 1 U i��- � !�l
Township Sectio� Ranoe Fire No. Countv _
Name
� aress ��oncraccor, �ompany or uwner rertortnmg mstan<
/ � it/.D �iJ�-
gn� trac or�Performing InstallaUon
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'IONS ON BAG YELLOW COPV eOARC
wide Two (2) Phone Numbers 1
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ConVactor License Number Master Electrician or Power Lim
�A O � � �� License Number
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Please Provide Two (2) Phone Numbers InGuding
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