P - 80499. REQUEST FOR ELECTRICAL INSPECTION
��-15 3- 7 5 3�, a`2; �°�e � A en�ue Su e'S 28, Saint Paul, Minnesota 55104
�? a���; (651) 642-0800 TTY/M RS 1-800-627-3529 /��
www.electricity.state.mn.us �2� '' '
Identify the work covered by this request: �./J�^ �'� Lr, ��1a1•fYU�a(+/ ���'!�0 � ,°�'0,�` O� <2f'�% �
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❑NEW ❑REMODEL ❑ADDIT�ON REPAIR /dG`FI�i�D�sl`Gri/Ck � a�E�C�T�aS���Gk /E{B:
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to B00 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 hGn �$5
0 to 200 Am ere � ,pp ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Ins ection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ction Tri s�$20
Each S stem Device or A ratus (� $.50 Investi a6ve Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unft (minimum total fee is $20) �-r
EaCh Additlondl Unit �$25 FOfl INSPECTOp USE ONLY
OTHER ADDITIONAL FEES �/,r'1 cl�2i—o I
Li htin Retrofit �$25 er Fi�Rure
Center Pivot Irri tion Boom �$40
ManUhdCtured Home Parlc LotS �$25 I hereby certily that I ins ed the electrical insTallaUOn described herein on tlre de�s stated:
Recreational Vehide Park Sites �$5 101�"'" °"'�
Se rate Bondin In ' n�$20
S ial Ins ection �$30 r Hour F"""'��"�' °"'�
S ial Ins ection �$.31 r Mile i ��' o` �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF T COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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ReQuest Date: Rough-in Inspeclion Required? ❑ Yes No Inspection Other Than Rough-In: eady Now ��11 Call
"�' � You must call the inspector when readyl Date Ready: �y'��
I certiTy that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (Street, Box, or Rou[e NoJ ONy Zip Code
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Power Supplier Address
Electrical Contractor / Company Name Contractor License Number Master License Number
Mailing Addre {Contractor, Company or Owner Perfortning Installation)
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E6�00001A-13 /t/2000 D ELECTRICRY COPY - IN87FIUCTION3 ON BACK OF YELLOW COPY