P - 771361 s�c �_ n o� � REQUEST FOR ELECTRIC� INS�CTI � ���
�d ' 0 � Minnesota Board of Electricity � Q�, ��j a �
1821 University Avenue Suite S-128, Sai aul, Mi nesota 551 �"
50 9 D 8o Q� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -%'sing the back of the white copy if necessary - the wf rk covered by this request: �/ � -/ J
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CIRCUITS I FEEDERS
0 to 200 Am ere $5 /
Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus $.50
ADDITIONS TO THE GENERAL FEES
Each Additional Unit
Center Pivot Irtiqation Boom
Supplemental Fee � $20
Transformers u to 10 KVA �$10
Tra�sformers over 10 KVA �$ 20
Transformer I Power Su I for Si ns I Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Fee
TOTAL FEE I � ��
total fee is $20) .
that I inspeded the electrical installation described herein on the dates stated:
DAiE
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
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Date: Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: � Ready Now �Vill Call
9 7/�7 You must call Uie inspector when ready! Date Ready: , \
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I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job SRe SVeet Address City /
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OwnedOccupant Name . Please Provide Two (2) Phone Numbers Including Area Code
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, ompany or Owner PeAorming Installation) � 1 ��/D /
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or or Owne rforming Installation) Please Provide Two (2) Phone Numbers li
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