P - 82533r REQUEST FOR ELECTRICAL INSPECTION
1-� o g 5� 4 9 6 ��; 8121 Unover � A en�ue Su te'S 28, Saint Paul, Minnesota 55104
� � � (651) 642-OS00 TTY/M RS 1-800-627-3529
www. electriciry.state.mn. us
work covered by this request:
❑ REMODEL ❑ADDITION ❑ REPAIR
401 to B00 Amoere �
O to 200 Ampere � $
Above 200 Amoere �
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
.TIFAMILY DWELLINGS (PER UNIT)
3 to 12 Units �$50 Per Unit
Manutactured Home Park Lots �
Recreational Vehicle Park Sites �
:�
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transtormers over iD KVA � $20
Transformer / Power Su for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelli Unit �$6(
AddRional Insoection Trips � $20
(minimum total fee is $20) �T
: �� � �
that I inspected the electrical installaGOn desaibed herein on tlie dates sl
wa
an,
6 -,tz
FoR or�cE use oN�v
IIIIII111lillltlllilillll�lll�Illfill�l�1111 ��� �'/ �
* 1 O 9 5 4 9 6 4 �4 �� �63i
R uest Date: Rough-in Inspection Required? es o Inspection Other Than Rough-In: ❑ Ready Now dl Call
�,�� You must calt the inspec[or when ready� Date Ready:
I certify that t am the ICENSED CONTRACTOR ❑ GOMPANY ❑ OWNER and hereby request inspection of the electrical work at: