P - 81792REQUEST FOR ElECTRlCAL INSPECTION
�� V J�- 5 5 8 f�e, $121 Unover ity A e�ue SuttelSt 28, Saint Paul, Minnesota 55104
(651} 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us '��
Identify the work covered 6y th'rs request: y L� , � � ��� r�
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR � �/�
GENERAL FEES Outdoor Li htln Standard �$t
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am re �$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 Circufts and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addi�onal Ins ion Tri s�$20
Each S stem Device or A aratus (� $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinsnedion Fee � S20
MULTIFAMILY DWELLINGS (PER UNI�
3 to 12 Units (� $50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fixture
Center Pivot Irri afion Boom �
Manufactured Home Park Lots i�
Recreational Vehicle Park Sifes .
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total fee is
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Special Inspection � $.31 per Mile � `C�j'a'!/Z� '�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 1 MONTHS
FOR OFFlCE USE ONLY
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Reque ate: Fough-in tnspect(on Required? ❑ Yes ❑ No Inspection Other Than Rough-In: Ready Now � WiN Call
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You must caN the inspector when readyl Date Ready:
I ce�ify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
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Section Township e Fire No. County
Occupant Phone
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Power Supplier Address
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Authorized
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EB•00001A-73
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9o�pr Owner �e�forming Install�
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80AFiD OF ELECTRIptt COPY
Phone
License Number
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4 ON BAd( OF YELLOW COPY