P - 76393(� REQUEST FOR ELECTRICAL INSPECTION �`�
2� 019 �.7 �� � Minnesota Board of Electricity �
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0800TTY/MRS 1-800-627-3529 www.electricity.state.mn.us ' � '�
Des ribe -using the back of the white copy if necessary - the work covered by this request: �
� ✓ 1 `-'�- i�C7
° GENERAL FEES Outdoor Lig ' Standard $1
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am ere $25 Su plemental 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 re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
A ove 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
Each System Device or Ap aratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 ta 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lightin Retrofit $25 per Fixture
Center Pivot Im ation Boom $40
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5
Se arate Bondin Ins 6on $20
Special inspection $30 per Hour
Special ins ion $.31 per Mile
THIS tNSrALLATION MAY BE ORDERED DI
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�OL99667
Reins ection Fee $20
TOTALFEE �^
(minimum total fee is $20) �7 - �
n TNIS NREA FOR INSPECTOR USE ONLY
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I hereby certify that I inspected the el 'pl installation desaibed herein on the dates stated:
RW GH IN DATE
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FIN4LINSOECTION �^ ' DATE
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ECTED IF NOT COMPLETEn WITHIN 12 MQNTHS,________�
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Date: Rough-in Inspection Required? Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ill Call
� '" ✓ You must call the inspector when ready! Date Ready:
I certi(y that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Street Address Ciry�--
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Fire No. Counry
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Please Provide Two (2) Phone Numb�
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Utility hl�CtnC21 U61rty Address —
�ompany Name � i G�'< --. GontractorLicense Number Master Electrician or Power Lim
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idress (ConVactor, Company or Owner PerformingJnstallation) /
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�Signature (Co ctor or Owner rformin stall ') Please Provide Two (2) Phone Numbers Including
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