P - 77660c REQUEST FOR ELECTRIC L INSPECT ��
1� 8 6 9_� V H Minnesota Board of Electricity p�Q��- ��� ��
1821 University Avenue Suite S-128, Saint Paul, Minnesota 551 �� �
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(651) 642-0800 TTYIMRS 1-800-627-3529 www.electricity.state.mn.us ���
Describe -using he back of the hite copy if necessa - the work covered by this request: .
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GENERAL FEES Outdoor Li hting Standard @$1
SERVICES I POWER SUPPLIES Traffic Sianal Standard (a� $5
0 to 400
0 to 200 Am ere $5 f� `
Above 200 Am ere 10
ALARM, COMMUNIC ION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUIT OF LESS T 50 VOLTS
Each System aratus @ $.50
ADDITION 0 THE GENERAL FEES
MULTIFAMILY DWELLIN PER UNIT
3 to 12 Units @$50.Per Unit
Each Additional Unit`
OTHER ADDITIONAL FEES
Li hting Retrofit @$.25 per Fixture
Center Pivot Irriaation Boom (� $40
Supplemental Fee $20
Transformers u to 10 KVA a$10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / Outline Li htin $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
Additional Inspection Trips @ $20
Investiqative Fee
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total fee is $20, v �•
I hereby certiTy that I inspected the eledncal installation described herein on the dates stated: �
S ecial Inspection $30 per Hour E%°'R�o' "en"°�
S ecial Inspection $.31 per Mile
� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF
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WITHIN 12 MONTHS
Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: �{2eady Now ❑ Will Call
�(�, �o� .. 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:
Job Site Street Address ��y
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Township Section Rarge Fire No. County
Ow edOccupant Name Please Provide Two ) Phone Num rs Including Area Code
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Utility •
�r/ omoanvName
rical UtilityAddress
License
or Power
iacwr ui vw�roi renormmg ins[ananOn) �ease rrow[le I wo (Z) Nhone Numbers Including Area Code
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OP YELLO�C Y BOARD OF ELECTRICITY COPY ca.nnnme_�s n� onnn