P - 79502REQUEST FOR ELECTRICAL INSPECTION a,E
1����- 2 3 9 �� z 8121 U overs � A eoue S tte'S 28, Saint Paul, Minnesota 55104
� (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us " '
Identity the work covered by this request:
❑ NEW ❑ REMODEL ❑ A6DITION .�HEPAIR ��� ��� �v� 5 ���`l.
GENERAL FEES Outd�r Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere t� d d• Q7 Su lemental Fee �$20
401 to 800 Am ere �$50 Transiormers u to 10 KVA �$10
Above 800 Amoere �$75 Transformers over 10 KVA �$20
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus (� $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units (� $50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fixture
Center Pivot Irri ation Boom �$40
Manutactured Home Park Lots � $25
Recreational Vehicle Park Sites �
Se arate Bondin Ins ectioR �$20
S ecial Ins ion �$30 er Harc
Special Inspection � $.31 oer Mile
Transformer / Power Su I for Si ns / Outline Li htin (� $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two inspection Trips Each Dwellin Unit �$8(
Addftional Ins ection Tri s�$20
Investi ative Fee
Reins ection Fee (� $20
TOTAL FEE
. � 3zf+eG (minimum total fee is $20'
FOR OFFICE USE ONLY
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ihatlinspected the electricatinstallaGon described herein onthe dates stated:
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D IF NOT COMPLETED_WITHIN 18 MONTHS __
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I certify that 1 am the �10ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: