P - 76703REQUEST FOR ELECTRICAL INSPECTI��.
��� 2�� 2 6 g� 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
e ribe -using the back of the white copy if necessary - the work vered by this request:
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GENERAL FEES Outdoor Lighting Standard @$1
SERVICES I POWER SUPPLIES Tra�c S' nal Standard $5
0 to 400 Ampere @$25 Su lemental Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Amoere Cc� $75 Transformers over 10 KVA (�a $ 20
UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
Center Pivot Irrigation Boom @
Manufactured Home Park Lots
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
� investigative Fee
Reinsqection Fee na, $20
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I herebvi certiN that I
TOTAL FEE � �—�j
total fee is $20)
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i the elecmcai instananon aescrioc� ��,.,,.... _
DATE
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� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Date: Rough-in Inspection Required? ❑Yes ❑No Inspection OtherTha ough-In: ❑ Ready Now ❑Will Call
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�;� "' :��? (,S � You must cail 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 SRe Street Address City
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Township Section Range Fire No. County
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Owner/Occupant Name Please Provide Two (2) Phone Numbers Induding Area Code
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Electripl Utility ElecUical UtiIRyAddress -- _ w
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Address (Contractor. Comoanv or Owner Perfoi
or
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INSTRUCTIONS ON BACK OF YELLOW COPY
Contrador License Number I Master ElecUidan or
License Number
illation) Please Provitle Two (2) Phone Numbers Including Area Code
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BOARD OF ELECTRICITY COPY E8-00007A-15 e i�nn� �