P - 82458REQUEST FOR ELECTRICAL INSPECTION
1� 0 3 2-10 3 ���° S121 U Over ity A eoue S tte'S 28, Saint Paul, Minnesota 55104
, s �em (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
Identity the work covered by this request: �� / „^�5� � M� I
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❑ NEW ❑ REMODEL ❑ ADDITION p REPAIR
401 to 800 Am ere (�
Above 800 Am re �
CIRCUITS / FEEDERS
0 to 200 Amoere � $
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
Each Additional Unit � $25
OTHER ADDITIONAL
Center Pivot Inigation Boom � $
ManuFactured Home Park Lots �
� $30 per Hour
� $.31 oer Mile
Outdoor Li htin Standard � $1
TraHic Si nal Standard � $5
Sup lemental Fee � $20
Transformers u to 10 KVA C� $10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htln �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, All
Circuils and Two Inspection Trips Each Dwellin Unit �$8(
Additional Ins ection Tri s(� $20
Investi ative Fee
Reinsoection Fee � $20
(minimum total fee is $20) -
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1 herebvi ceAifv that I insoected the
described herein on tlie dates slated:
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FOR OFflCE USE ONLY
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Request Date• � Rough-in Inspection Requfred? ❑ Yes ❑ No Inspectlon Other Than Rough-In: Ready Now ❑ Will CaH
` You must cell the inspector when ready! Date Ready:
i certiy that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at