P - 81813REQUEST FOR ELECTRICAL INSPEGTION
1°� 0�- 0 9 3� 8�21 U overs� A enue S tte'St 28, Sai t Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-352
www.electricity.state.mn.us �j
Identity the work covered by this request: �_��
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR � C �" �
GENERAL FEES Outdoor Li tin Standard �$1
SERVICES / POWER SUPPLiES Traffic S nal Standard �$5
0 to 400 Am ere �$25 Su temental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns I Outline Li htin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelli Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S stem Device or ratus �$.50 Investi ative Fee
ADDITlONS TO THE GENERAL FEES Reinscection Fee �$20
3 to 12 Units �$50 Per
Lighting Retrofit � $25 per Fixture
Center Pivot Irrigation Boom � $4(
Manufactured Home Park Lots � $
Recrea6onal Vehicle Park Sites �
total fee is
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5 e�cfal In�ection � $.31 �r Mile �2—PZ--I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE U8E ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No inspecti�on OUier Than Rough-In: Ready Now Q Will Call
� 9` Q You must call the inspecta when readyl Date Ready:
I certify that I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request ir�spection of the electriral aork at
Job Address (Sheet, Box, or Fl6Lte No.) _ Cify ^ '1;. �c;;o° ` �
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Occupant
Power Supplier
2619 Coon
Bivd. NW
No.
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EB-OOOOtA-13 7/2000 BOARD OF ELECTpICITY COPY MISTRUCT10N8 ON BACK OF YELLOW COVY