P - 77282REQUEST FOR ELECTRICAL INSPECTION
1� 6 7 6- 5 0 9 a gy� Un�iversity A enue Su'rt�e S- 28, Saird Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricitystate.mn.us
O NEW 0 REMODEL O ADDITION REPAIR Describe -using the back of tlie wlwte copy'rf n��IhBjxork coveied by this requesh
s # 16� - I
GENERALFEES
SERVICES I POWER SUPPLIES
0 M 400 Am re $25
401 to 800 Am e E50
Above 800 Am re E75
GRCUITS / FEEDERS
o to 2(l0 Am re E5
Above 200 Am S10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or us E.50
ADDITIONS TO THE GENERAL FEES
MULTIfAMILY DWELLINGS PER UNI
3 to 12 Units @ S50 Per Unit
Each Additional Unit @ b25
OTHER ADDITIONAL FEES
' hGn Rehofit $25 r Fixture
Center Pivot Irri ation Boom $40
Manufaclured Home Park Lots 525
Recreational Vehicle Park Sites $5
arate Bondin Ins tion $20
S'al Ins 'on S30 r Hour
S ial Ins 6on $.31 r Mile
THIS INSTALLATION MAY BE ORDERED DI
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16765091
Tralfic
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includ� the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @ S60
TOTALFEE I
(minimum total fee is $20) � �
nau�wrtra�c,aaus� �•
I hereby ceNfy that I inspec�ed the elecpical insfall�on destxibed herein on the da�s st�ed:
T COMPLETED WITHIN 12 N
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�ceQues� �eie: Rough-in Inspection Required? ❑ Yes No Irupection Other Th� R
/ ough-In: y Now ❑ Wfll Call
Z/3 05 Vou must wll the inspeclor when ready! pate Ready:
-T
I certiy that I am the �.�iCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request e�spection of the electrical work at: