P - 77413, REQUEST FOR ELECTRICAL INSPECTION
1�� 4 7� 5 2 8 8121 Urovers � A enue Su tte'S 28, Saint Paul, Minnesota 55104 �
(651) 642-OS00 TTY/MRS 1-800-627-3529 �
www.electricity.state.mn.us
Identity the work covered by this request: �� CA � l � n� „Q
t � J�
❑ NEW ❑ REMODEL ❑ ADDITION � REPAIR
0 to 400 Am ere �$25 ' J
401 to S00 Am ere �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIflCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apparatus �$.50
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIOP
Lighting ReVofit � $25 per Fixture
Center Pivot Irrigation Boom d$40
Manutactured Home Park Lots � $
Recreational Vehide Park Sites � �
Separate Bonding Inspection � $2(
Special Inspection � $30 per Hour
Special Inspection � $.31 cer Mile
Traffic Siqnal Standard � $5
Su demental Fee (� $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Oudine Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$80
Additional Inspection Trips � $20
Investiaative Fee
thatlinsoected the electricalinstalla6on
total fee is
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
I IIIIli IIHI lilll lllfl 11111 llill lilll llili lill llll
�E 1 3 4 7 5 Z 8 O�
R uest, Dat��� ough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: dy Now ❑ Will Call
� You must call the inspector when readyt Date Ready:
I certity that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, or ute NoJ � City Zip Code
Z� -�� , � -� ,��� �erDL� S'�� 3 �.
Section Township Range Fire No. County �
-e f
Address
W�
Phone
��� ��i�
�
,� � � � - �q�'
:ompan or Owner Perfortning Installation) � �
�
to Company or Owner Performing nstellation)
�C
BOMD OF ELECTRICRY COPY
Master License Number
-p� n �Q
f
INSTRUCTIONS ON BA K OF YELLOW COPY