P - 78896REQUEST FOR ELECTRICAL INSPECTION
�� 6 6 6- 4 7 2� 8�21 Un�ersB�� e 3uite S-128, Saint Paul, Minnesota 55104
(651) 642-080Q�Y/MRS 1-800�27-3529 www.electriciry.sta[e.mn. us
0 NEW ❑ R ❑ ADDITION ❑ REPAIR Describe�sin the back of thewhite copy if necessary - the work covered by this request:
� � � �
GENERAL FEES 0 or Li htin Standard $1
SERVICES I POWER SUPPLIES c Si nal Standard $5
0 to 400 Am re S25 lemental Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am re $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer / Poww Su i for S' ns / Outline L' htin S5
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service andlor Power Supply up W 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Txro Inspection Trips Each Dwelling Unit � S80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins tion Tri $20
Each Svstem Device or Aoo�atus � 5.50 Investiaative Fee
MULTIFAMILY DI
3 to 12 Units
Each Additio
Fbur
I IIII II III I� �II Ii lli 11111 II III II II� II III �� I�
1 6 6 6 4 7 2 4
0
I cerMy iMat I am
(minimum total fee is $20) � �� j
TNIS MEA FOR INSPELTd2 USE OKY
I hereby ceAify that I inspected the elechical instaUa4on desaibed herein on Ihe daffis sfa0ed:
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Raighin InsPection Required? ❑ Y� ❑ No InsPeUion Ofher Than
Rough-In: dy Now O Ylfill Call
You must call the inspector when ready! Date Read :
Y
LICENSED CONTRACTOR ❑COIu�ANY ❑ OWWER and hereby reque.st inspectpn of the electrical work at:
E&00001M14 8.1.2002