P - 76481REQUEST FOR ELECTRICAL INSPECTION °
1-787-925 5 Y ���
❑ Minnesota Board of Electricit ;�--
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 �+•ti+•x.electricih�.s7ule.mn.us
Describe -using the back of the white copy if neqgs��! - the�9 rk 4ye�ed by,(�igr� �st; � �
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-6+a`JERAL FEES Outdoor Liqhtina Slandard (�a $1
to 800
+e 800
>IFEE
5 Supplemental Fee @ $20
$50 Transtormers u to 10 KVA $10
$75 Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns I Outline Li htin $5
4..t ONE & TWO FAMILY DWELLINGS, EACH UNIT
$10 Includes the Service andlor Power Supply up to 500 Amperes, All
J. REMOTE CONTROL. SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNITI
Unit
Pivot
Boom a
'ark Lots
Fee
Fee
TOTALFEE ��sl,!�(7
total fee is $201
I hereby ceRify lhat I inspected the electrical installation described herein on the dates stated:
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Special Ins ection $.31 per Mile
TH#S I!lSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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�. Uate: � i Rou h-in Ins ection Re uired?
g p q ❑ Yes �] No '� Inspection Other Than Rough-In: [�Ready Now ❑ Will Call
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I � I You must call the inspector when ready! Date Ready:
I certify that I am khe �] LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Street Address City' j,� j i_ '"" ""
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Section '�� Range
OwHnte�dOcc7u�pant Name �
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Fire No.
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County
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��.. Eloctrical Utility i Electrical Utility Address
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Contractor / Company Name - � Contractor License Number Master Electrician or Power Limited Technician
i i � r i i i i' � -� ^'"�t �` �� I' � i E?" I License Number
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� Mailing AddreSS (Contractor, Company or Owne7r� Performin� Installation)
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IA anxl S' nature (Contrector or Owner Performing Installation) I Please Provide Two (2) Phone Numbers Including Area Code
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