P - 78054�SU�� REQUEST FOR ELECTRICAL INSPECTION
1_"��—��� � g121 Un�ers� Aven 8uite S- 28, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW M06EL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
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ENERAL FEES Outdoor Liahfina Standard � E1
401 to 800 Am re S50
Above 800 Am re 575
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 GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Li htin Retrofit $.25 er Fixture
Center Pivot Irri ation Boom $4U
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5
arate Bondin Ins tion $20
S ial Ins ion $30 er Hour
S iallns tion $.31 Mile
THIS INSTALLATION MAY BE ORDERED DI
I I�II II III �I�II �� I�I II II) I� �I II III II (II �� I�
15311152
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$BO
Investi ative Fee
Reins ction Fee $20
TOTAL FEE ,1 �
(minimum total fee is $20) �v
THIS AREA FOR INSPECiOR USE p1v
I hereby certity that I inspected the electrical installation described herein on the dates stated:
R�01� �05°
Request Date: Rough-in Inspection Required? ❑ Yes Inspedion Other Than Rough-In: ❑Ready Now ��ill Call
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l� � 3 j� You must call the inspector when ready! Dale Ready:
I certify that I am the �ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecGon of the electrical work at::