P - 77636REQUEST FOR ELECTRICAL I SPECTION � a����
1� J_ �•O -12 8� Minnesota Board of Electricity pCi /� �- �
r 1 8 2 1 U n i v e r s i t y A v e n u e S u i t e S- 1 2 8, � i n t P a u l, M i n n�� 5 5 1 0 4 �.
�"���'�' (651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us �;;�g?�
Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERALFEES
0 to 400 Ar
401 to 800
Above 800
:UITS, CIRCUITS Of LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
Each Additional Unit @
Lighting Retrofit @ $25 per Fixture
Center Pivot Irriqation Boom (a� $4(
1 per Mile
Outdoor Liqhtinq Standard (�a $1
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer / Power Supply for Signs / Outline Lighting @$5
ONE & 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
TOTALPEE
total fee is $20)
I hereby certiy that I inspeded the electrical installation described herein on the dates stated:
ORDERED DISCONNECTED IF
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COMPLETED WITHIN 12 MONTHS
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Date: Rough-in Inspection Required? ❑Yes � Inspection OtherThan Rough-In:�eady Now ❑Will Call
���/ � You must call the inspector when ready! Date Ready:
I certify that I am the/�❑CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electncal work at:
Job SRe Street Address City (��
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Township Sedion Range Fire No. County
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Owner/Occupant Name Please Provide Two (2) Phone Numbers Including Area Code
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Electrical Utility Electrical Utility Address
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Contractor / Company Name Contractor License Number Master Electrician or Power Limited Technician
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Mailing Address (Contractor, Company or Owner Performing Installation)
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Author' Signature (Co ^actor or Owner orming Installation) Please Provide Two (2) Phone Numbers Including Area Code
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