P - 80440REQUEST FOR ELECTRICAL WSPECTION
W
,� ��� O- 8 4 3 ���°vv S121 U oversity A eoue S te'S 28, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529
www.electricity.state.mn.us '� '
IdentiTy the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic S' nal Standatd C� $5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to S00 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS ! FEEDERS Transformer / Power Su i for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$1Q lncludes the Service and�a Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each Svstem Device or Aooaratus �$.50 Investiaative Fee
3 to
Li htin Retrofrt �$25 r Flxture
Center Pivot Irri tion Boom �$40
Manufactured Home Park Lots �$25 I hereby cemry
Recreatlonal Vehicle Park Sftes � �5 '�"'"
Se arate Bondi In ion � S20
S ecial Ins ion �$30 r Hour F""""�"�fON
S ial Ins ection �$.31 er Mile
�_THIS INSTALLATION MAY BE ORDERED DISCONNECTE
FOR OFFICE USE ONLY
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the
total fee is
on tl�e dak.a
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WITHIN 18_MONTHS
�E i i 8 O B 1i 3 3�E �'�cJ?�5 ��• s�
Request Date: Rough-in Inspectlon Required? ❑ Yes ❑ No Inspection Other Than Rough-In: Ready Now ❑ Will Call
fQ� �Q You must call the inspectw when readyl Date Ready:
I certify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Addre (Stree� x, =Route No.� Ciry� /) 2ip Code
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Section Township Ran e Fire No. Coun
occupaM /
Power S r
Elechic$I C�ordredor / C
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Casrt Rapids, !
Authorized SignaNre
EB-00001A-13 71
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Contractor License Number
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BOAAD OF ELEC7AICRV COPY
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Phone
License Number
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IN6iHUCT10NS ON BACK OF VELLOW COPY