P - 75874REQUEST FOR ELECTRICAL NSPECTION
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� � 1821 Unfversfty Avenue Suiie S-128, Pa , Mlnn ta 1 ;
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www.electriciry.state.mn.us •
Idendiy the work covered by this requ�st
' ❑NEW ❑REMODEL ❑ADDITION REPAIR �`
GENERAL FEES Outdoor Li hNn Stendard �$1
SERVICES / POWER SUPPLIES Traffic Si Slendard �$5
0 to 400 Am re �$25 emertlal Fee ��LO
`101 to 8� re �$50 Trflr�sformers to 10 KVA �$10
AbovB 800 Am re �$75 Translomrers over 10 KVA �$20 a.
GIRCUITS / FEEDERS Trar�sformer / Power for Si / Oudine LI htin �$5
0 to 200 re� ONE & TWO FAMILY DWEWNGS, EACH UNIT
Above 200 re�$10 Includes the Service a�M/or Powrer SaPPIy W ro 500 Amperas, Aq
ALAHM, CONQuIUNICATION, REMOTE CONTROL, SIGWWNG Circuits and Two I 'on Trips Esch Dwe�ing Unft �$BO
CIRCUITS, CIRGUITS OF LESS TFIAN 50 VOLTS Add�io�l Ire on T' C� $20
Each m Device or A �$.50 Investi ative Fee
ADDRIONS TO THE GENERAI. FEES Re on Fee �$20
MULTIFAMILY DWELUNGS ER UN '�pTp�, �
3 to 12 Un�1s �$50 Per Un� (minimum totel fee is $20) �,
EeCh Additior181 Unit �$25 wn wsrECrcn u� mnr
OTHER ADDf�ONAI FEES
LI Min Retroflt �$25 r Fbmrre
Cemer Pivot I an Boom �$40
ManufacWred Home Park Lots �$25 I hereby cemTy that I 6�spec[ed me electricel 6�1e0auon d�d herefn � the d�es s�0ed:
Recreatlonal VeMcle Park Sit� � $5 "�10H �' �*�
Se Bondin I on �$20 � , d,
S I n�$30 r Hour �"�'' ��
S ' Ins 'on � $.31 r N17e % �, -��
_ THIS INSTALLATION INAY BE_ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
I!II!!! Iilll Ilill IIIII 111f1 Ilili IIIII Illll Illi IIII
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Request Date: Rough-In Inspection R�uired? Yes ❑ No Inspectlon Other Than Rough-In: ❑ Ready Naw ❑ WIA Cell
�� Yau must cefl the tmpector when readyl Date Ready:
I certliy t I am the �LICENSm CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request irtspection o} the electrical work at
Job Address (Street, Box, or Route No.) Cily ap �8
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SecUon Township RenBe Flre No. Ca�mly
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Power Suppfler pA�ldr�
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�ectrlcel Contractor / Comparry Name ConLactor Lice�e Number Master License Number
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Mefling Address (Contrador, Company or Owner Per(orming Instelladon)
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Authorized Signature ( r, Compeny o r Pertorming Ir�stalletlon) Phorre
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EB-00001A-13 7 BOApD OF ELECTRICIiY COPY WSfRUCIIONB ON BpCK OR YELLOW COPY