P - 81960REQUEST FOR ELECTRICAL INSPECTfON
�!�1 � 1- 5 4 5 A�� $121 Unrvter ity A en�ue Sude'S 28, Saint Paul, Minnesota 55104 �
� � `� � e„ , (6b1) 642-08Q0 TTY/MRS 1-800-627-3529
�� www.electricity.state.mn.us
Identify the work covered by this request:
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR �J � �l�.t.t.C_S� ��� 1 / '
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic S� na! Standard �$5
0 to 400 Am re �$25 Su lemental Fee C� $20
401 io 800 Am ere �$50 Transformers u to 10 KVA �$10
Above S00 Am ere �$75 Transformers over 10 KVA �$20
C RCUITS / FEEDERS Transformer / Power Su for Si ns / Outline Li h6n �$5
0 to 200 Am re�$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service and/or Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addftional Insoection Trios �$20
MULTIFAMILY DWELLINGS PER
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
Center Pivot Irrigation Boom � $40
Manufactured Home Park Lots � $
Recreational Vehicle Park Sites � ;
Separate Bonding Inspection � $2(
S 'al {ns 'on � $30 r Hour
Fee
totaf fee is
on the dates stated:
S ial In ion � $.31 per Mile _ � ��� L / ' � � / I
THIS fNSTALLATION MAY BE ORDERED DISCONNECTED I COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now Will Call
�y "� O�' l You must call the inspector when readyl Date Ready:
I certily that I am the (�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecfion of tlie electrical wo�k at:
Job Address (Street, Box, or Route NoJ City Zip Code
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Section Township Range Flre No. CouMy
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EB-00001A-13
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NaO�e.,.�., �NG►. Contrador License Number Master License Number
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