P - 82430REQUEST FOR ELECTRICAL INSPECTION
����2 3� 0�`t �� $'21 Un��iversity Aven�ue Su tte'S 28, Saint Paul, Minnesota 55104
� ;�a`:� (651) 642-0800 TTY/MRS 1-500-627-3529 / �
www.electricity.state.mn.us �p�'�
Identify the work covered by this request:
EW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
SERVICES I POWER SUPPLIES
to 400 Am ere � $p2Cf'
401 to 800 Am ere �$
Above 800 Am re 75
CIRCUITS / FEEDEEiS�
0 to 200 ere � $5
Above260 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units (� $50 Per Unft
Each Additlonal Unit � $25
Center Pivot Irrigation Boom � $
Manufactured Home Park Lots �
�
I�'
Outdoot Liahtir�a Standard �
Su lemental Fee � $20
Transformers u to 10 KVA (� $10
Transformers over 10 KVA � $20
Transfortner / Power Su I for Si ns / OuHine Li Min �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, PJI
Circuits and Two Inspection Trips Each Dwellin Unit �$8f
Additional Insoection Trios � $20
total fee is
areb ceitify that I inspected the electrical insqllation described � an tlie date
�iHIN //�/�
. �� �_ " ' _ '/ 1 w. .
FOR OFFICE USE ONLY
' �ii��i ��i�i �1ii� ���ii i��ii i�t i�i�i i�» ii�i �j� j,� � .
3E 1 O 2 3 O 1 4 c �E '�/`�
st Date� Raugh-in Inspection Requfred? es ❑ No Inspection Other Than Rough-In:
(_X.J You must call the inspector when ready! Date Ready:
Ready
rtiy tPf�t 1 am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspeclion of tlre eledrical work at:
JobAddr�e��r��' C��NTRAL AVEMUE �� FRIDLEY, MN �p�
Sec[ion Township Range Fire No. County� �
°�1pA"tSTEVE FISCHEk Phone
Power S pplier Address
�s�P 28 ��
Electricall�q'R�ii SPi�e�e�CTFt I C CO. co�c�ac�o� uce��e�4b Master License Number
Mailing A�is���ha���or����iner�o�s ��� � CNAMRL I N� MN 55316
Authoriz ture (CoMractor, Compa r Owner erf i Installation) Phone
EB-00001A-13 1/2000 BOApD OF ELECTRICITY COPY � INSTRUCTIONS ON BACK OF YELLOW COPY