P - 76054REQUEST FOR ELECTRICAL INSPECTION
1� 3 4 7- 4 8 4� M�1 UniversKY A enue SuitenS-128, Safnt Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.m�.us
Identlfy the wark covered by this requ�
❑NEW � ODEL ❑ADDITION ❑REPAIR ��LQ�Ul1-- �
GEPIERAL FEES OuOdoor LI Stendard �$1
SERVICES / POWER SUPPLIES Tra�c Si Siandard C� $5
0 to 400 �$25 S lemetdal F� �$'10
401 to 800 Am re �$50 Transiomrers to 10 KVA �$10
Above B00 �$75 Trarusfomrers over 10 KVA �$20
CIRCUITS / FEEDERS Transtormer / Power Su for Si / OutMe LI htl �$5
O to 200 Am re�$5 � ONE 8 TVJO FAMILY DWELLINGS, EACH UNIT
Above 200 re C� $10 ' Inctud� the Service arid/or Power Suppty up to 500 Am�res, M
ALARM, COPAMUNICATION, REMOTE COPITROL, SI(iNALING Ciradts arM Tvro Inspectlon Tri� Each DweOing Unit �$80
CIRCUITS, CIRCUITS OF LESS TFIAN 50 VOLTS Ad�IIGonal I�s on T �$20
Each m Devtce or A (� $.50 Im�U ative Fee
ADDITIONS TO THE dENERAL FEES Re 'on Fee ��0
MULTIFAMILY DWELLINdS ER UN TOTAL FEE
3 to 12 Units �$50 Per Unft (minimum totai fee is $20) �
EBCh Add�tlonal UNt �$25 wn w�crwi � anr
OTHER ADDRIONAL FEES � T
LI Retrafit � $?S r FbRure
Center Pivot I' on Boom �$40
ManutecUired Home Park Lots @$25 I he certtly tf�t I iaapected the e�l IremOatlon d�bed herein on the da6es smD�:
R�reatlonal Vehide Park Sites �$5 �'"' DA7E
Bomlm Ins on � $20 � �� � �
S I on �$30 r Hour �°'�10N s°Ah
S I n�$.31 r NNUIIe ?-e3 �) tltc �
THIS INSTALLA7'iON MAY BE ORDERED DISCONNECTED IF NOT COMP D WITHIN 4@'MONTHS
— � —
FOR OFFlCE USE ONLY �
. ��- ���b
I Illill Illfi IIIII Illil 11111IIIII IIIII IIIII III! Illl ��
�E ] 3 4 7 4 8 4 6 3�
I certHy that I em the ❑ LICENSED CONTRACTOR ❑ COMPANY � OWNER end hereby request inspecHon of the electricel work at
Job Address (Street, Box, or Route NoJ City / Zip Code
�1 r� /,cJc��� � �✓2�4�1 '> j �'3 Z
Section Tomishfp Range No.
�i�:� � � �� � P�� � � 5/ �, , / 3
Paroer Suppller Addreas
�' 'rL.�
dectrical Contractor / Compeny Name Corrtractor License Number Mester Llcense Number
S �.� �
MatMg Address (Contractor, Company or Qwner erformi� I`� on)
� 1' 1 � (.ue� � v1—�s� i�r� �4 h
or Owner Performing Instellatlon) � Phorte
� ��� � �� � �� � 9
, • BOAND OF ELECTFi1C17Y COPY a1S�RUCT10N8 ON BACK OF YELLOW COPY