P - 75857REQUEST FOR ELECTRICAL IIVSPECTION
1� 3 4 7- 515 � M�y � B� Avenue Sulte S-128, Saint Paul, Minnesota 55104 �
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us ��� O ��/
Identlfy ffie work covered by this request ��� s; ,.,���
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❑ NEW ODEL pADDITION ❑ REPAIR L 7i/�'L �.c
GENERAL FEES Outdoor Li SiarMard C� $1
SERVICES / POWER SUPPLIES Trartic SI Siandard �$5
0 to 400 re �$25 lemenial Fee �$'LO '
401 to 800 Am re�$50 Transformers to 10 KVA �$10
Above 8� Am re �$75 Trenstormers over 10 KVA �$20
CIRCUITS / FEEDERS Trenslormer / Power S for Si / Outdne Li htfi �$5
0 fi 200 re�$5 a� 8 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 2� Am re�$10 Includaa the Service and/or Power Suppty up ro 500 Amperes, M
ALARM, COMMUNICATION, REMOTE CONTFlOL, SIGNALING Cira�ts and Taro Irtspectlon Trips Each Dwe�ng Urtit �$80
CIRCUITS, CIRCUffS OF LESS THAN 50 VOLTS Adddonal I 'on T' �$20
Each Device or A �$.50 Im�ati ' F�
ADDRIONS TO THE GENERAL FEES Reins n Fee f� $20
MUL77FAMILY DWELLINGS ER UN TOTAL FEE (j'p-1
3 to 12 Units �$50 Per Untt (mmimum total fee is $20) �'[ 0• `
Each Additlonal Unit �$25 �a+ u�cmn usE aiar
OTHER ADDITIONAL FEES
Li ' Retrofit �$25 r Fixture 2
Cer�ter Pivot irti eUon Boom �$40
Manufectured Home Park Lota ��5 I here that I tr� tlre elechi�l tr�smuatmn d� herein ai the da� stffi�:
Recreatlomdl Vehtde Perk Sites �$5 aattw w uare �
Se Bo I on � $20 `���
S I on �$30 r Hour � �����.
S I on �$.31 r M8e
THIS INSTALLATION AAAY BE ORDERED DISCONNECTED IF NOT COMPLETED WRHIN 18 MONTHS
FOR OFFlCE USE ONLY ��� 5.
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Requ Date: �� Rough-In Inspectlon RequfredT Y� ❑ No InspecUon Oifrer Than Rough-In: ❑ Reedy fVow LYi➢ Cell
�! You must call ttre inspec[or when readyl Date Ready.
I certiiy tl�at I am the ❑ LICENSED CONTRACTOR ❑ COMPANY OWNER and hereby request inspectlon of ffie ele�trical wrork et
Job Address (Sbeef, Box. or No.) cily Zip Code
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SecUon Township _ Renge _ Flra No. ,,, 1 e
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E&00001A-73 7/tl2000
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P���3-5-71-���2
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ning InstellaUOn)
BOAAD OF ELELTHICITY COPY
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M9'TFIUCTIONS ON BACK OF YELIOri COPY ,