P - 75932REQUEST FOR ELECTRICAL INSPECTION
�-�����"� � 821 Unive � Aven e Suite 5-�128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-80D-627-3529 www.electricity.state.mn.us
Describe -usi the bacA�f the white copy necessary - the ork cover� by this request:
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GENERAL FEES door Li htin Standard @$1
SERVICES / ROWER SUPPLIES iaffic Signal Standard @$5
0 to 400 Am re@$25 •-? , Su Iemantal F� $20
401 to 800 Am re$50 Transfortners u to 10 KVA $10
Above 800 Am re @$75 Transformers over 10 KVA $ 20
CIRCURS / FEEDERS Transformer / Power Su I for Si ns / Outlina Li hG $5
0 to 200 Am re$5 ��+ ONE 8'fW0 FAMILY DWELLINGS, EACH UNIT
Above 200 Am re$10 Includ� the Servtce and/or Power Supply up W 500 Am�res, A�
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspecdon Trips Each Dwellmg Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS AddiUonal Inspectlon Trips @$20
3 to 12 Units Q$50 Per Unit
Each Addfional Unit @ $25
OTHER ADDRI01
Lighting Retrofit @ $.25 per Fodure
Ce�er Pivot Irtigation Boom @ $40
Manutactut�i Home Park Lots @ $
Recreadonal Vehicle Park Sltes @'
Separate Bondir�g I�pecdon (a� $21
S�cial Insaectlon Ca� $30 aer Hour
TOTALFEE B/
total fee is $201 70� °
I herebvi cerdfv that I� 6re elecLical h�taVadon desa@ed herehi on the datea st�ed: I
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s mspecnon m�a� r rv�ne
TH1S INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
FOR Of FICE USE ONLY
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�: Rough-in InspecUon Requhed? ❑Yes o Irtspecdon OtherThen Rough-In: Ready Now OWiO Ca0
��� Iv � You must call the inspedor when readyl Date Ready.
I certify that I am the,�JCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hareby r�uest inspection of the electriral work at
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ompany or Owner Pertortning Installadi
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dor or Ovmer Performina Instellation)
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idar Licet� Number Master Electridan w Power Limf[etl
CAo � 2� 3 `�"� ""��-io �589
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