P - 81712REQUEST FOR ELECTRICAL INSPECTION
1��✓ `t J- 4 5 0 ��LL 8'2� Un'oiver ity A en�ue SuteriS 28, Saint Paul, Minnesota 55104
��� �� � (651) 642-0800 TTYIMRS 1-800-627-3529
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www.electricity.state.mn.us ''�'
Identity the work covered by this request: /_ S' 1
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR
(30 �-j � f A.c,I.S� Yl �.� � -7 _ �
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Amoere �$25 Su lemental Fee (� $20
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Un'�ts �$50 Per Unit
Each Additionai Unft � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 er Fixture
Center Pivot Irriaa6on Boom � $40
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Inciudes the Service and/or Power Supply up to 50Q Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$8C
TAdditional Inspection Trips � $20
Investi aGve Fee
Reinsnection Fce � $20
total fee is
Manufactured Home Park Lots �$25 I hereby certify that I inspected the elechical installation desaibed herein on tlie �tes stated:
Recreationa! Vehicle Park SRes �$5 101GH1N �'�
Se arate Bondin Ins ion �$20
S ecial Ins ection � $� er Hour �'" °'BPC�tON �— //� . °ATE
S ecial Ins ion (� $.31 r Mile z--�
SNL�JNSZni i e�K�y_g�pRnFRFn ��(�y�(;TED_!�F NAT [_nYpLF�D WITHIN 18 MONTHS
Fon o�ce usE on�r
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Request Date: Rough-in Inspection Required? ❑ Yes No lnspection Other Than Rough-In: ❑ Ready Now Wfll Call ��
�' �� , You must call tlie inspector when ready! � � Date Ready: � � �
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (Sheet, Box, or Route No.) Cily Zip Code
l��A �. i mhe.� 12��d t frr7'�i,(�u �SSy� �.
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W—i � L c` .0 S
Power Supplier Address
e1`�����a.°yi�1� ELECT., INC.
13562 VENtRF►L AV�. N.E.
Mailing Address o erforming Installation)
Phone
`��3- s7� -
Master License Number
AUthO�ized i atUfe (G tIa mpany or c�ner Pertormi 1860�) Ph0 B
, `�(�3-767� (� ��
E&00001A 13 7/1/2000 BOppD OF ELECTNICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY