P - 81946REQUEST FOR ELECTRICAL INSPECTION
1�� ��- 4 2 6 ��, 8121 Urnvers � A en�ue Su tetSt128, Saint Paul, Minnesota 55104
(651) 6A2-0800 TTY/MRS 1-800-6273529
www.electricity.state.mn.us
Identity the work covered by this request: � ✓� � ��� � � `� � �
❑ NEW ❑ REMODEL DITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Sta�dard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Sup lemental Fee �$20
401 to 800 Am re W$50 Transformers u to 70 KVA �$10
Above 800 Am re �$75 Transtormers over 10 KVA �$20
UITS ! FEEDERS Transiormer I Power Su for Si ns ! Outfine Li htin �$5
0 to 200 Am re �$5 ONE R TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Indudes the Service and�or Power Suppty up to 5�0 Amperes, AII
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALIN� Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins 'on Tri s�$20
Each S stem Device or ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinsoection Fee �$20 `�
OTHER ADDITIONAL FEE
Li htin Retrofit �$25 er Fixture
Center PivW I' ation Boom �$40
Manufactured Home Park Lots �$25 � certity mat I i�ted tfie elecUical instaNaSon described herein on Cie daoas stated:
Recreational Vehicle Park Sites � $5 "q101N °p"'�
Se rate Bondin Ins ection �$20 — p "O
S �al In 'on �$30 r Hour """ �"10" DA7E
S ial Ins ion �$.31 r Mile Z� Q 1
TH{S INSTALLATION MAY BE ORDERED DISCONNECTED 1 T COMPLETED WITHIN 18 MONTHS
FON OFRCE USE ONLY
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Fieques[ Date: Rough-in Inspection Requir Ye o {nspection Other Than Rough-In: ❑ Ready �If Catl
(�j'� � You muat call the inspeclor whe readyl Date Ready:
I certify that I am th L ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
.bb Address (SGeet, Box, or Ro e No.) Cily �� /� Tip Code
�Q 1
Section Township ange ire No. County
7
OccUD'dnt � � ,�—� �� / Phone � _ � � /1i �. �
;;77 SH�7REVI�W �`AI-`ll� F��i>'>i = ,
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� an�eer r R Abirning Installatio�)
rg (Eontractor, Compa9Y er Perfo,�ming lnstalls
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BOARD
fAX: (651) 490-0670 �
INSTpUC7pN8 ON BACK OF YELLOW COPY