P - 78084REQUEST FOR ELECTRICAL INSPECTION _ �-- -
.
1' S 2 9— 3 9 3 9 M���e�� Boa� of E��G�, J : •
1821 University Avenue Suite S-128, Saint Paul, Minnesofa 55104
(651)642-0800TTY/MRS 1-800-627-3529 www.electricity.state.mn.us " "`�
❑ NEW ❑ REMODEL O ADDITION REPAIR Describe -using the aack of the white copy if necessary - the xrork covered by this request:
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GENERAL FEES Outdoor Li htin Standard Si
SERVICES I POWER SUPPLIES Trafic S' nal Standard SS
0 to 400 Ampere � E25 Suoolemental Fce �$20
401 to 800 Am ere $50
Above 800 Am E75
CIRCUITS / FEEDERS
0 to 2(10 Am e E5
Above 2(10 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or atus S•50
ADDITIONS TO THE GENERAL FEES
2 Units @ $50 Per Unit
Addition� Unit � S25
fit � a.zs a�� F�M�re
ngation Boom @ yW
Hane Park Lots � 3
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Grcuits and Two Inspection Trips Each Dwelling Unit �$60
TOTALFEE
(minimum total fee is $20) � O,,�p
TMI$ AFEA Fdt NSPECiOR USE Cf1Y
I hereby ur0y that I inspec0ed Ihe electrical install�on describeG herein on the dates sfa0ed:
F�,Y � � 6 �-t, 4
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� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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�Q� �e: Rough�n Inspection Required? O Yes No Inspadion Otlier Than RwgMn: ❑Ready Now Will Call
�Z -� 7- O� You must call the inspecta when ready! Date Ready.
I certiy that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby �equest inspection of the electrical work at::
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