P - 78013REQUEST FOR ELECTRICAL INSPECTION
�-��"— O�� a g121 Unrv rsity AvenueESui�S- 28, SaiM Paul, Minnesota 55104
(651) 642-08Q0 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
�R� ��EL C� A�ITION ,� AIR Describe -u 'n the back of the ' e copy ' n essary - the w covered by is request:
( %l! Gi C T o% /{ r/� G'Cl' �
GENERAL FEES Outdoor Li htin Standard $t
�/ POWER SUPPLIES __ Traffic Sianal Standard (� $5
0 to 400 Am ere S25 �'
401 to 800 Am re $50
Above 800 Am re $75
CIRCUITS I FEEDERS
0 to 200 Am re $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus $.50
ADDITIONS TO THE GENER,4L FEES
Each Addi6onal Unit
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTAL FEE I � �
(minimum total fee is $20) ;
iH15 MEA Fdi iNSPELTOR USE pdr
I hereby certify that I inspected the electrical installation deuribed herein on the dates stated:
FEES fJ�/L� /1-Z-i`��3
Nl�t d -4'- °`�
per Mile � �
MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 1
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Request D e: Rough-in Inspection Required? ❑ Yes Inspection Other Than Rough-In: ady Nav � �Yill Call
` t b O You must call the i�spector when ready! Date Ready:
I certiy that I am ihe ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Address (Str , Box, or Route No.) Ciry Zip Code
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: EIECTRIC, ING.
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MN 55�4`,. ,.� _
BACK OF VELLOW � � BOARD
71v� S-7! - (o(��>
�e Numb Master Electrician or Power Limited Technician
� cense Number
t �,«,e �s>
EB-0OOO1M14 8.1.2002