P - 80541REC�UEST FOR ELECTRIGAL INSPECTlON
��� q. � 7 1 8 �� v_ 8121 UnOVers � A eoue Su ter'St 28, Saint Paul, Minnesota 55104
'" (651) 642-0800 TTY(MRS 1-800-627-3529
www.electricity.state.mn.us '��
Identify the wark covered by this request:
❑NEW EMODEL �ADDITION ❑REPAIR [Gl LC.(�i�
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES i POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere d$25 Su lemental Fee �$20
401 to 800 Am ere (� $50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transtormers over 10 KVA �$20
CIRCUITS / FEEDERS 7ransformer / Power Su I for Si ns 10utline 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 CONTROI, SIGNALING Circuits and Two Inspection Trips Each DweNina UnR C� $80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus f� $.50
ADDITIONS TO THE GENERAL f
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Uniis �$50 Per Unit
Each Addftional Unit � $25
OTHER ADDITIONAL FEES
Li Mi Retroffi (� $•25 r F'ature
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots �
Recreationai Vehicle Park Sites �
Se rate Bondi Ins 'on � $20
S ial In �$30 er Hour
Special Inspecdai � $.31 cer Mile
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I hereby ce ' that I inspecled ihe electrical installallon described herein on the dates stated:
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NNECTED IF NOT COMPLETED VyJ'LHIN 18 MON
FOR OFFICE USE ONLY
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Req st Date: Rough-in Inspection Required? Yes ❑ No Inspectlon Other Than Rough-In: ❑ R�dy Now Will Call
�� Z �� You must cali the inspector when readyl Date Ready: �
i certiiy that 1 am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electricai work at:
Job Address (Sheet, Box, or Route No.) City Zp Code
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Power Supplier Address
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CoMractor License Number
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BOAFiD OF ELECTRICRY COPV INBTRUCTIONB ON BACK OF YELLOW COPY