P - 77249REQUEST FOR ELECTRICAL INSPECTION
1� 6 7 5-16 8�7 g�2� Unrv rs� Aven e 3�ifie S- 28, Saint Paul, Minnesota 55104
(651)642-0800'I`TY/MRS 1-800�27-3529 www.electricity.state.mn.us
❑ REMODEL ❑ ADDITION 0 REPAIR Describe -using the back of the white copy if necessary • the work covered by this request:
i.cJ/2E ��t2N�t�.E
GENERAL FEES Outdoor Li htin Standard $1
i/ POWER SUPPLIES Traffic Si nal Standard $5
00 Am re $25 Su lemental Fee $20
� 800 Am re E50 Transfortners u to 10 KVA S10
a 800 Am re E75 Transformers over 10 KVA E 20
/ FEEDERS Transformer / Power Su I for Si ns I Outline Li htin $5
00 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
: 200 Am re $10 Includes ihe Service andlor Power Supply up to 500 Amperes, All
�MMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Txro Inspection Trips Each Dwelling Unit @$80
CIRCUITS OF LESS THAN 50 VOLTS Addilional Ins tion Tri $20
S stem Device or atus $.50 Inves6 ative Fee
ADDITIONS TO THE GENERAL FEES Reinsoection Fee !�a S20
3 to 12 Units @$50 Per Unit
Exh Additional Unit @ $25
Ligh6ng Retrofit @ $.25 per Fixtu2
Center Pivot Irtigatioa Boom @;4C
Manufactured Home Park Lots � S
IIII IIII� IIIII II�1 II�II IIIII (IIII IIIII �� I�
16751687
TOTAL FEE I S�p
(minimum total fee is $20) �O --
TNI$ AREA FOR IIbPECiCQ USE p1Y
I hereby ceAily Mat I inspected the electrical installa6on described herein on ihe dates sfaled:
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D DISCONNECTED IF NOT COMPLETED WITHIN 12 MQ
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rcequest uate: Rough�n Inspection Required? U Yes � No Inspection Other Than Rough-In: �1Ready I�bw ❑ V1lII Call
,� �'�9 �C%� Vou must call the inspecta when readyl Date Ready.
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY � OWNER and hereby request inspection of the elecfical work at: