P - 77648REQUEST FOR ELECTRICA INSP �{TIQN �`°�
I QQ�% Minnesota Board of Electricity ���'(/�(j�� �� �
1��J V 1- 6� 5 0 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �'
(651)642-0800TTY/MR 00-627-3529 www.electriciry.state.mn.us
Describe -using the back of the white copy if necessary • the work covered by t' request:
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GENERA FEES door Liphting Standard (iD $t
I SERVICES /
Above 800 Am ere a$75
CIRCUITS / FEEDERS
0 to 200 Am ere $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE �ENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Liqhtinv ReVofit na $.25 oer Fixture
i Home Park Lots 1
Vehicle Park Sites
Standard
� Transformer / Power Supply for Signs I Outline Lighting @$5
ONE & TWO FAMIIY DWELLINGS, EACH UNIT
includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwel.ling Unit @$80
Additional Inspection Trips @ $20
Investiaative Fee
TOTAL FEE
(minimum total fee is $20) � � � �
I inspected the elecVical installation described herein on the dates slated:
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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�ate: Rou h-in Ins ection Re uired?
I�// ' g p q ❑ Yes No Inspection Other Than Rough-In: Ready Now ill Call
�� i�i � You must cail 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 /� ��
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Township Section Range Fire No. Cou�
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Elect� I Utility Ele
Contrador / Compan � Name
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Maifing Addr s(Contrador, Com� any r Owner Perfom
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Aut orized Signature (Contractor or Owner Performinq
o�tle Two (2) Phone Numbers Including Area
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Gontractor License Number Mas er Electrician or Power Limited Techni
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Installation)
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�Ilation) Please Provide Two (2) Phone Numbers Including qrea Code
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