P - 80524<
REQUEST FOR ELE�TRICAL INSPECTION
1� 1R5 3� 1� 1 �%3 8'2� Unrvter � A en�ue Su telS 28, Saint Paul, Minnesota 55104
(651) 642-0800 TfY/MRS 1-500-6273529
� www.electricity.state.mn.us
Ide�tify the work covered by this request: 1"`� S TQI��,�_ �•� �W /� /�C � j 7"S .�d �Q �! h GJ �� R, E�
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❑ NEW ❑ REMODEL ❑ ADDITION REPAIR �Z �7 e uT % k C.' �t v%d X�''� li S� L� �7`S
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee C� $20
401 to S00 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS I FEEDERS Transformer / Power Su for Si ns / Outline Li htin �$5
i 0 to 200 Amoere �$5 �.!�� 7, cr� ONE & TWO FAMILY DWELLINGS, EACH UNIT
)MMUNICATION, REMOTE CONTROL, SIGNAIING
CIRCUITS OF LESS THAN 50 VOLTS
ystem Device or Apparatus � $.50
ADDITIONS TO THE GENERAL FEES
OTHER ADDITIONAL FEES
I Home Paik Lots �
Vehicle Park Sites �
�dina InsoecUon � $�
Includes the Service and�or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$80
Additional Ins ection Tri s�$20
Investi ative Fee
Reinsoection Fee � S20
that I inspected the electrical installation
tac�i i� is $2oi I y',?.sc�I
5'al I ection �$.31 r Mile � � B`l �� O/ I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED 1 NOT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Ya5 o Inspection Other Than Rough-In: eady Now ❑ Will Call
'�� � You must call the inspector when readyl Date Ready: '� �`
I ceRi(y that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (Street, Box or Route No.) City Zip Code
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Section Township Range Fre No. Co My
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Contractor License Number Master License Number
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B D OF ELECTHICT( COPY IN37AUCTpNS ON BACK OF YELLOW COPY