P - 81924REQUEST FOR ELECTRICAL INSPECTION
� 1-131- 9 41 �1�� 8121 Unover ity A eoue Su terlS 28, Saint Paul, Minnesota 55104 _�
(651) 642-OS00 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
IdentiTy the work covered by this request: J
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR /�/� �
GENERAL FEES Outdoor Li htin Standar �$1
SERVICES I POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Ampere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su for S' ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Senrice and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Ins ection Trips Each Dwelli Unit �$60
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS AddRional In ion Tri s�$20
Each S tem Device or ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinsoection Fee � 820 _
OTHER ADDITIONAL FEES
Lighting Retrofit � $25 per Fixture
Center Pivot Irtigation Boom � $40
Manufactured Home Park Lots � $25
Recreational Vehide Park Sites � $5
Seoarate Bondina Insoection � $20
I hereW cerliffv that I inspected the electriral
total fee is
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S ecial Ins ection �$.31 per Mile l /
THIS INSTALLATION MAY BE ORDERED DISCONNECTE OT COMPLETED WITHIN 18 MONTHS
WN OFFlCE USE ONLY
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Requ Date: Rough-in Inspection Required7 ❑ Yes ❑ No Inspection Other Than Rough-In: Ready Now 0 Wfl� Call
You must call the inspec[or when readyl Date Ready:
I certi(y that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (SVeet, B, or Route No.) ^ T�j(y ���..� Zp Code
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� Occupant
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Contr�or License Number Master License
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BOAHD OF ELECTRICfTY COVY
Phone
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IN87AUC710NS ON BACK OF YELLOW COPY