P - 766972-111�064 �
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I SERVICES /
REQUEST FOR ELECTRICAL INSPECTION a� -...
Minnesota Board of Electricity S�`
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104 �;
(651) 642-OS00 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us ���
�- the work covered by this request:
C�cus�%� GSr--�7�- 7�sf�S
Outdoor Lightin Standard @ $1
Traffic Siqnal Standard f�a $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus $.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 per Fi�ure
Center Pivot Irriaation Boom (� S40
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / Outline Li htin $5
ONE 8 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
Additional Ins ection Tri s $20
Investi ative Fee
Reins ction Fee $20
TOTALFEE �,.1 �
(minimum total fee is $20) �(J
THIS AREA FOR INSPECTOR USE ONLV
I hereby certiy that I inspected the electrical installation desaibed herein on the dates stated:
Special Inspection $30 r Hour ExP�a�o� ooNeo oA,�
Special Inspection $.31 r Mile �` f�.S" �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT OMPLETED WITHIN 12 MONTHS
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Date: Rough-in Inspection Required? ❑ Yes �' No Inspection Other Than Rough-In: ❑ Ready Now �(Vill Call
/��— U� You must call the inspector when ready! Date Ready:
I cerfrfy that I am the �{LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Street Address Ciry
lD � �(o �-�hson i�irGY�P
Township Section Range Fire No. County
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Utility Address
I Coon Hapids, MN 55433
� Mailing Address (Contradw, Companv or Owner Perfc
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Nlease Provkie Two (2) Phone Numbers
(�63)s��.�SE�7y ( )
Number Master Electrician or Power
��� License Number
Nlease Prov�tle Two (2) Phone Numbers
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