P - 75805RE(�UEST FOR ELECTRICAL�NSPECTION
��3 ��- 5 4 5� 821 Un�tversii� Avenue S�uite S-128, Saih'i P�Min�esota 55104
(851) 642-0800 7lY/MRS 1-80�627-3529
www. electricity.state. mn. us
IdenWy the work overed by this reUuest ,/� rn r p
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❑NEW REMODEL ❑ADDITION ❑REPAIR (i�. �,EWZ,j�
GENERAL FEES oor htln Stendard �$1
SERVICES / POWER SUPPLIES Trattic SI Siartdard �$5
0 to 4�0 Am re�$15 S lemerdal Fee �$'LO
401 to 8� re�$50 Tianstomrers to 10 KVA �$10
Above 800 re �$75 Trarustormers aver 10 KVA f� $20 `
IRCUffS / FEEDERS Transtomrer / Power S I for / OuH'me ' �$5
0 to 200 Am re �$5 ONE & 7W0 FAMILY DWEWNGS, EACH UNR
Above 2� re�$10 Includ� the Service and/or Power Suppiy up to 500 Amperes, AA
ALARM, CONWIUNICATION, REMOTE CONTROL, SIGNALING Ciradis and Taro Inspeclion Trips Each Dme@ng Urtit �$'BO
CIRCUITS, CIRCUffS OF LESS THAN 50 VOLTS AddiL'onal I on T �$20
Each m Devtce m �$.50 Imie,atl Fee
ADDITIONS TO THE GENERAL FEES R n Fes �$20
MULTIFAMILY DWEWNGS ER UN TOTAL FEE
3 ro 12 Units (� $50 Per Unit (minimum tatal fee is $20) ��J�
EaCh Adti'iUonel Unit � $25 �' °�'TOP "� 01�r
OTHER ADDRIONAL FEES
LI Retrofit � $25 r FaWre
Cerder Pivot Irti ation Boom �$40
Manufactured Home Park Lots �$'25 I mat I Ns�D� tlre eled�iml i�llenon d�cr�d here6� on ihe dams smted:
Recreatlonal Vehide Perk Sit�s C� $5 "�°' P1 0p7E
Bo Ir� on C� $20 ��
S '81 I 'on C�? $30 Hour `w"`�1°" �7 °A�
S ' Irts on @ $.31 r Mae � � � � ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED F NOT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY
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Request Date• Rough-(n InsspecUon RequlredT es ❑ No Uiapectlon Other Than Rough-In: ❑ Ready Now A Cap
(0 0�^ You muat ca0 tlre inspector when readyl Date Ready:
I certity that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY [+}QWNER and hereby request inspection of the electrical vuo�C at
Job Address Box. r No.) C(ry Zfp �����
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Secdon Township Hange Flre No. County
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Power Suppuer ��� Address � � �
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�ectricel ConUacior / Company Nart�e Corrirector License Number Master License Niunber �
ddr�s (Co�actor, Com� or Owner Perfomdng Inslallatlon)
d Signehue (Contrector, Co y or Owner Petformtrcg 1 on) Phone �� ��� � �
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13 7HP2000 BOApD OF ELECTRICITY COPY INSRiUC(IONS ON BACK OR YELLOW CAPY