P - 80517REQUEST FOR ELECTRICAL INSPECTION
1��� V� 418 ��; 8121 U over � A eoue Sute'S 28, Saint Paul, Minnesota 55iO4
(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
SERVlCES / POWER SUPPLlES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers up to t0 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS I FEEDERS Transformer / Power Su for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE 8 TWO FAMILY DWELLINGS, EACN UNIT
Above 200 Am ere �$10 Includes the Service ancllor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUtTS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri �$20
Each S stem Device or aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 72 Units �$50 Per Unit (minimum total fee is $
Each A�litional Unit � $25 w"'"'�C0""�ONLY
OTHER ADDITIONAL FEES � �. )l �dt
Li htin Retrofit �$25 er Fixlure � r
Center Pivot Irri ation Boom �$40
ManufaCtured Home Pa�k Lots �$25 I here certify that I inspected the electrical insfallation �saibed herein on the dete.a stated:
Recreational Vehicle Park Sites �$5 101GH1N °ATE
Se arate Bondin Ins ection �$20
S ecial Ins �$30 r Fiour FNNPLNS°`�TON . DA7E
S ial Ins eclion �$.31 r Mtle ��
__ THIS I_MSTAL_LATION MAY BE_ORDERED DISCONNECTED IF NOT COMPLEI'ED WITHIN 18 MONTHS
FOR OFFICE USE ONLY ��� ,
I{Illll III�I Illll III�I Ilill IIIII IIlII I�II! I�IIlIII �o-s-�
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Req t Date: Rough-in Inspection Required? ❑ Yes ❑ Mo lnspection Other Than RougF�-In: Ready Now � WIII Call
` l�' O/ You must call the inspector wF�en readyl Date Ready:
i cer�ty tl�at I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Addrese (SUeet, x, w Route No.) Ciry Zip Code
— 7S �� '� .�
Section Township Range Fre No. County //M^/� ��
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OccupaM Phone
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Aower Supplier A ess
r . CoMractor License Number Master License Num
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er Pertorming Installation)
Authorized Signature a, Company a Owner Pertorming tion) Phone
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EB-OOOOlA-13 7/1/2000 OMD OF ELECTRICITY COVY UC7pN8 ON BACK OF YELLOW COPY