P - 81631REQUEST FOR ELECTRICAL INSPECTION
�����- 7 0 6� $121 Un�ver � A en�ue SuRte�S 28, Saint Paul, Minnesota 55104
(651) 642-OS00 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us '' '
Identify the work covered by this request: � � j �% f
❑NEW ❑REMODEL ❑ADDITION EPAIR �" �5� �� '" S��v�lu��Qu—S ['C��CkI�
GENERAL F E Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traitic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transfortners up to 10 KVA �$10
Above 800 Am re �$75 Transformers over t0 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su for Si ns / Outline Li htin (� $5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Suppry up to 500 Amperes; All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING CircuRs and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri �$20
Each S stem Device or aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee �$20
FOR
OTHER ADDITIONAL
Manufactured Home Park Lots �
total fee is
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inslellatlon described herein an ihe da�s
S ecial Ins ection �$30 er Hour '"°'°" � w�� � 30. G/ I
Special Inspection � $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFflCE USE ONLY
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Request Date: Rough-in Inspeclion Required? ❑ Yes o Inspection Other Than Rough-In: eady Now ��II Call
� � Ot �' � fl You must call the inspector when ready! Date Ready: f jZ ^��
I certity that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection o1 the electrical work ar
Job Address (Street, Box, or Route No.) Cky � rp Code
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INSTRUC710NS ON BACK OF YELLOW COPY