P - 76502REQUEST FOR ELECTRICAL INSPECTION '�
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I � � � � � _ � /� r� � Minnesota Board of Electricity 2 /y�� /�/�� �. :�
�•} L 1821 University Avenue Suite S-128, s�t ba`u( inn�ot 1 4 �.
(651)642-0800TTY/MRS1-800-627-3529 www.electricity.state.mn.us
Describe -using the back white py if necessary - the work covered y this r est:
GEN RA FE oor Li htin tandard $1
SERVICES / POWER SUPPLIES raffic Si nal Standard $5
0 to 400 Ampere $25 Supplemental Fee @$20
401 to 800 Am ere $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 I Outline Li htin $5
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ction Tri s $20
Each System Device or Apparatus @$.50 Investigative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE
3 to 12 Units @$50 Per Unit (minimum total fee is $20) �
Each Additional Unit @$25 rHis aaEn FoR wsaECTOa usE oniv
OTHER ADDITIONAL FEES
Lighting Retrofit @$.25 per Fixture I hereby certify that I inspected the electrical installation described herein on the dates stated:
Center Pivot Irri ation Boom $40 Ro��" �" oArE
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5 1N5PECT10N �' �� oA�
Se arate Bondin Ins ction $20 `��y""'—"—� –� _ �,[
Special Inspection $30 pBf HOU� exaiaeo�nenruooneo op�
S cial Inspection $.31 r Mite
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS ____
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D/atg�: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: eady Now ❑ Will Call
/ �a ,r�is You must call the inspector when ready! Date Ready:
I certi(y that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Address ��� ,
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Township Section Range Fire No. County
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Owner/Occupant Name - Please Provide +o �hone Numbers Including Area Code
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ElectricalUtility � ElectricalUtilityAddress --
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Contractor / Company Na e Contrador License Number Master Electrician or Power Limited Te nician
DEPENDABLE ELECTRIC, INC. License Numbe�/� i
Mai�ing ( r Perfortning Instaltation) �� ����_�
Coon Ra id N 55433 �
Authorized Sign ontractor or Own Pe rming Installation) Please Provide Two (2) Phone Numbers Including Area Code �
-�' � �'�-�� �_�.� 75" 7 �S�d �
_ I RUCTIONS ON BACK OF YEL�.d01��OfY �� BOAR� OF ELECTRICITY FR-OOOOtA_15 n� �nne