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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: ' �5l-���-� 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 v 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::