P - 764841-787-899 2❑
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- GENERALFEES
:S I WER SUPPLIES
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity ; :
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 --
(651) 642-0800 TTY/M RS 1-800-627-3529 wx�ir. electrreiry. state. mn.:is
!�.the .cq�te�e�;by�hi�s Sgquest; _
_.._ .�; �h.;i •.�r!vC '� :�WT i"4:'i
bove 200 Ampere @$10
A, COMMUNICATION, REMOTE CONTROL, SIG
IFS, CIRCU�TS OF LESS THAN 50 VOLTS
ach System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
FAMILY DWELLINGS (PER UNIT)
to 12 Units @$50 Per Unit
3ch Additional Unit @ $25
OTHER ADDITIONAL FEES
qhting Retrofit @ $.25 per Fixture
anter Pivot Imgation Boom @ $40
anufactured Home Park Lots @ $25
3creational Vehicle Park Sites @ $5
�ardte Bo�diru� Inspection @ $20
�eci� tnspection (a� $30 cer Hour
Outdoor Lighting Standard @ $1
Traffic Siqnal Standard (a� $5
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer I Power Supply for Siqns I Outline Li htin $5
ONE 8 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
Additional Inspection Trios (cil $20
TOTALFEE �(7�5fy
nimum total fee is $20)
that I inspected the electrical installation described herein on the dates s�ated:
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�ISTALI.ATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 72 MONTHS _
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.`�"' j Rough-in Inspec[ion Required? ❑ Yes �[] No '� Inspection Other Than Rough-In: [�Ready Now ❑ Will Call
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�, �. i You must call the inspector when ready! � Date Ready: I
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I certify that I am the Lj LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
— --_ __ __ _...__ _ _ __ ___ _ _
- Job Sde Sfrett Address . .... . .- - . . . . — — . Tt�t 1
, i r_ � City �- �", S il � � �I !�j 1.,, �:.� [:� � �i , i
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i Townshi ...._ j---- �--9 -- � Fire No. i County
P Section � Ran e i
', Please Provide T i} f'' �
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� OwneUOCCUpant N,ame �� wo (2) Phone Numbers Including Area Code
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, Eledrical UtJit - � i Electrical U[ility Address
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',' Contractor / Company Name �.. Contractor License Number Master Electrician or Power Limited Technician
�ii�i'f� i=��C, i�F:il_' l;3,'l!'i���iti:(-'!! i'..1�'i L.I�� (jfi�i;;'i ILicenseNumber
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� Me�6n Address�Contractor Com any or Owner Performingy,In�stallation
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,�?�('1 IF'4'i111�F'•`.1�!. �';�It��Jy _':'41.IiI ��f-���L..� j11� ����j'! �r1
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q r�zsd S turc (Contractor or Owner Performing Installation) Please Provide Two (2) Phone Numbers Including Area Code
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�$TRUC7lON5 ON BACK pF YELLOW COPY BOARD OF EIECTRICITY COPV EB-00001A-15 8.1 2004