P - 80166REQUEST FOR ELECTRICAL INSPECTION �
1� 3�2 3- g 3 2� S121 Un��ivers� A en�ue SuRteIS 28, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-6273529
' www.electricity.state.mn.us
Identity the work covered by this request:
❑NEW ❑REMODEL ❑ADDITION ❑REPAIR R�.on n�� V(. � � 1
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Siandard C� $5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS I FEEDERS Transformer I 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 re �$10 Includes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS AddiUonal In ion Tri s�$20
Each S stem Device or A aratus f� $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fce �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units � S50 Per Unit (minimum total fee is $20)
Lighting Retrofit � $25 per Fixlure
Center Pivot Irrigation Boom � $4C
Manufactured Home Park Lots � $
Recreational Vehide Park SRes � '
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I herebv ceAitv ihat I inspected the electric:al insfalla0on destxibed herein on
Se rate r�onain ins ec�ion ��eu �-
S ial Ins ion �$30 r Hour `�"""�"0H �'�
S ecial In ection �$.31 r Mile 2—L —°�
THIS INSTALLATION MAY BE ORDERED DISCONNECTE COMPLETED WITHIN 18 MONTHS
FOR OPFICE USE ONIY
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R uest Date: Rough-in Inspection Required? ❑ Yes ❑ No inspec[ion Other Than Rough-In: Ready Now ❑ Will Catl
�'� —l1� You must call the inspector when readyl Date Ready:
I certify that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the eledrical wak at:
Job Address (Street, Box, or Route No.) City T�p Code
� '�'�"' - �r I
Section Township Range Fire No. .
0
ElecVical Contracfor / Company Name
DEPE�VDABLE �'L�°�T(�#�. +IRfG.
M i dr t p' edc
�eon Rapids. MfV b5 3
Authorized Si9nature dor, Companv or Owne1�
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Phone
�1 C�3 - 5 ��-1 - a (Q
CaMractor License Number � Master License Number
ming Installation)
ertorming Installation)
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E&00001A-13 7/t/2000 BOAHD OF ELECTAICRY COPV � INSTRUCTIONS ON BACK OF YELLOW COPY