P - 81729REQUEST FOR ELECTRICAL INSPECTION
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1� O� t- 2 2 3 � 8121 Un��iverBy A en�ue S tte'S 28, Saint Paui, Minnesota 55104
„ ����� (651) 642-0800 TfY/MRS 1-800-627-3529
www. electrici ty. state. �nn. us
identify the work covered by this request: ��� �%7� ,p „� ��� � ��,2 (�ti� N��%;� N 1�(
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❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPA{R
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$70
Above 800 Amoere �$75 Transformers over 10 KVA (� $20
Above 200 Ampere � $10 �
RM, COMMUNICATION, REMOTE CONTROL, SIGNALING
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus �$.50
3 to 12 Unfts �$50 P
Each Additional Unit (�
FEES
Center Pivot Irrigation Boom � $4
Manufactured Home Park Lots �
Recreational Vehicle Park Sites �
� Transformer I Power Supply for Signs i Outline Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
CircuRs and Two Inspection Trips Each Dwellin Unit �$80
Additional Insoection Trips � $20
Fee �
total fee is
linsoected the electricalinstalla6an described herein on the dates stated:
� � Special Inspection �$ 31 per Mile � � ,�—1 l7 " v/ I
_ THIS WSTALLATION MAY BE ORDERED DISCON_NECTED IF_NOT COMPLETED WITHIN 18 MONTHS ___
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inapection Otlier Than ftough-ln: ❑ Ready Now Call
�� v ��� You must call the inspector when ready! Date Ready:
I certify that I am the fNSED CONTRACTOA ❑ CON{PANY ❑ OWNER and hereby request inspection of the eiectrical worfc at:
Job Address (Street, Box, w Route No.) Ciry 7-�P C�1e
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Section Township Range Fire No. County
OccupaMn Phone
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Power Supplier Address
Elecfical CoMractor / Company Name Cantractor License Number Master License Number
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Mailing Address (CoMractor, Company or �vrrer Performing Installation)
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Autho ' ed ignature ( ractor ny or er Performing Insta tion) Phone
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EB-00001A-13 1/2000 80ARD OF ELEC7RICRY COPY INSTRUCTIONS ON BACK OF YELLOW COPY