P - 77755REQUEST FOR ELECTRICAL INSPECTION
1� 1� V� 5 81 6� �gp� Unversity Avenue 3uite S-128, Saird Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
0 NEW 0 REMODEL ❑ ADDITION R AIR Describe -u ' g tde back white co�py'rf necessay - the work covered by this request:
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GENERAL FEES Outdoor ' htin Standard S1
SERVICES I POWER SUPPLIES TraffiC S' nal Standard E5
0 to 400 Am re E25 Su tal Fee $20
401 to 800 Am e E50 Tr�sfartiers u l0 70 KVA E10
Ahove fY10 Amr�n [�D t7S . r.�..cc,.....� ,...e. � n �nie ca c �n
ALARM, COMMUNICATION, REMOTE CONTROI
GRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus @ E.50
ADDITIONS TO THE GENERAL I
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units 0 E50 Per UnN
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
GrcuiLs and Two Inspection Trips Each Dwelling Unit @ SBO
TOTAL FEE � �
(minimum total fee is S20) ' ��
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5 ial Ins 'on $30 r Hour �D'"�"'a0A
S '� Ins 'on i.31 Mile
HIS INSTALLATION MAY BE ORDERED DISCONNECTED IF
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OMPLETED WITHIN 12 MOI�
�V �� s" Rough�n Inspection Required? ❑ Yes I�pection OlFier 1
Yau must call the inspedor when ready! pe� R�Y
I certiy that I am the LICENSED CONTRACTOR ❑COMPANY ❑ OWNER and I
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AAailing d.ess cormacro , comae�Y g Own
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WSTRUCTONS K OF YELLOW COPY '
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'ng Instaqation)
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BOARD OF ELEC7RICRV COPY
�In: y.lpeady Now LJ WNI Call
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inspection of Uie electrical worlc at:
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mber M�x e�tr;aen a Pax� Lim�
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EB•OOOOtA-14 8.1. Z002