P - 76597(� REQUEST FOR �t�CTRICAL INSPECTION ���'�
1� 8 2 �J' s Q, �� � Minnesota Board of Electricity s� �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
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(651)642-0800TTY/MRS 1-800-6273529 www.electricrty.state.mn.us �t;�
Describe -using the back of the white copy if necessary - the work covered by this request:
GENERAL FEES Outdoor Lightin Standard $1
SERVICES / POWER SUPPLIES Traffic Signal Standard $5
0 to 400 Ampere $ Supplemental Fee $20
401 to 800 Am re $50 ` Transformers u to 10 KVA $10
Above 800 Am re $75 Transformers over 10 KVA $ 20
CIRCUITS I FEEDERS Transformer / Power Su I for Si ns I Outline Li htin $5
0 ta 200 Am ere $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or paratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lightin Retrofit $.25 r Fi�ure
Center Pivot Irriaation Boom C� S40
Special Inspection �$30 er Hour
Special Inspection $.31 r Mile
THIS INSTALLATION MAY BE ORDERED
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18204875
total fee is $20) � ��i �
I inspected the electrical installation described herein on Ne dates stated: �
IF NOT COMPLETED WITF
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12 MONTHS
°1' Rough-in Inspection Required? ❑ Yes � No Inspection Other Than Rough-In: ❑ Ready Now�Wil� Call
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��— i�p " Q S You must call the inspector when ready! Date Ready:
I certity that I am the ❑ LICENSED CONTRACTOR � COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Street Address ��,
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Township � Section Range Fi�e No. County .
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:upant Name
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/ Company Name
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�ress (Contractor, Company or O�
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iSig ture ( ontrac r Owne�
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BOARD OF ELECTRICITY COPY
Phone Numbers
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Master EleCtfician or Power
License Number
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