P - 82038ELECTRICAL INSPECTION
sota �oard of Electricity
' 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
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(651) 642-OS00 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us '� �
identify the work cavered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION EPAIR �_ �CJ v / i � � .�"� �
GENERAL F S Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Ampere C� $25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Ampere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GEMERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$5o Per Unit (minimum total fee is $20) ��
OTHER ADDITIONAL
Lighting Retro�t � $.25 per Fixture
Center Pivot Irrigation Boom � $40
Manufactmed Home Park Lots � $25
Recreational Vehide Park Sites � $5
Seoarate Bondina Insoechon � $20
I lierebv certN that I insoected fhe eleclrical
dates stated:
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 181VIONTHS
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FOR OFFICE USE ONLY
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R t Dat •�' Rough-in Inspedion Required? ❑ Yes No Inspection Other Than Rough-In: Ready Now ❑ Will Call
You must call the inspector when readyl ate Ready:
I certi(y that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical xrork at:
Job Address (Stre,et, Bqx, or Rou "� � n °-� ��� ;i^ Zip Code
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Power Supplier Ac
lect u I Contractor / Company Name
Mailing Address (Contractor, Company r Owner Perfi
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Auth 'zed 'anature (CoMractor. Cnmoanv or Owner
Fire No. ' � County
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Number I Master Li�nse
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