P - 77039� (� REQUEST FOR ELECTRICAL INSPECTION
1-�'7 1 0— 1 J 1 � Minnesota Board of Elecficity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/M 7-3529 www.electricity.state.mn.us
0 NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the b of copy if necessary - the work covered by this request:
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G ERAL FEES Outdoor Li htin tandard $1
SERVICES I POWER SUPPLIES Traffic S' nal Standard $5
0 to 400 Am re $25 Su lemental Fee $20
401 to 800 Am re $50 Transfortners u to 10 KVA $10
Above 800 Am e 375 Transfortners over 10 KVA $ 20
CIRCUITS I FEEDERS Transfortner I Power Su I for Si ns / Outline Li hGn $5
0 to 200 Am re $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am e$10 Includes ihe Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$SO
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins tion Tri $20
Each S stem Device or atus $.50 InvesG ative Fee
ADDITIONS TO THE GENERAL FEES Reins tion Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE
3 to 12 Units @$50. Per Unit (minimum total fee is $20)
iHISARFAFORIrLSPECT USEMr
EaCh Additional Unii @ 525 I hereby certify that I inspec0ed the elecbical instSNation described herein on Me dates sfaled:
OTHER ADDITIONAL FEES
Li h6n Rehofil $.25 r Fixture
Center Pivot Irri ation Boom a40 R01GH1N o"'E
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5 "�CTON �`''�+ /� ` °"TE
Separate Bonding Inspection @ $ZO ( "XdL L�---�...�. ! G�" / �—
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Request Date: Rough-in Inspedion Required? ❑ Yes No Inspection Other Than Rough-In: dy Now ❑ 1KII II
✓ � Q You must call the inspector when ready! Date Ready: (� .... ��
I certify that.t am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Sit� �(Street Box� a Route No.) w�� Cih' / � , Zip Cod�� ��
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Sedion Tawnshi ��� /_� Range Fre No. County
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Owner/Occupant Name �� Please Provide Two (2) Phone Number(s) Indud:ng Area Code
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Power lier Power plier dress
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Contrador / Company Name Contractof license Number Master Electrician or Power LimKed Technician
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ailing Address ( traclor, Company w Owner Perfortning Installation) �
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Auth ' re(CoMrBdor pany Own Perfo ing Instailation) Phone (s)
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