P - 82002REQUEST FOR ELECTRICAL INSPECTION
�.L -1�2 3- 8 9 5 ���a 851) 642t0800 ATfY/ RS t1e800-627 3529paul, Minnesota 55104
www.electricity.state.mn.us
identify the work covered by this request: '
❑NEW ❑REMODEL ❑ADDITION ❑REPAIR Cf� �`-�� C�'��� �
GENERAL FEES 0 r Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Sianal Standarcf ��5
401 to 800 Am ere �$50 Transformers u to 10 KVA 8$10
Above 800 Am ere �$75 Transformers over 10 KVA (� $20
;UITS / FEEDERS Transformer / Power Su I tor Si ns / Outline Li htin �$5
0 to 200 Am re �$5 ONE & NUO FAMILY DWELLINGS, EACH UNfT
Above 200 Am ere �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
RM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$8(
;UITS, CIRCUITS OF LESS THAN 50 VOITS Additional Ins ion T' s�$20
Each Svstem Device or Apoaratus �$.50 Investiaative Fee
OTHER ADDITIONAL FEES
Rehofit (� $25 cer Fixture
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Se arate Bondin In 'on �$20 C`
S 'al Ins 'on � $30 r Hour "'MLiBP`�"01
Special Inspection � $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETE[
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes'�#R6 Inspection Other Tria�
You must call the inspector when ready! / Date Ready: �
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I certify that 1 am the �iICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and he�e6
Job A dress (Street, Box, oute No.) ' City
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Section Township Range Fire No. County
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EB-00001A-13 7M/2000
total fee is
an
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request inspection of tl�e electrical work at:
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Name ConVactor License Number Master License Number
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npany or Owner Pertorming Insialfation)
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, C pany or Owner Performi I stallation) Pho
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BOMD OF ELECTpICRY COPY MISTAUCfWNS ON BACK OF YELLOW COPY