P - 77208REQUEST FOR ELECTRICAL INSPECTION
1� 7 2 2-� 2 3�0 g121 Unrv rs� Aven eESu te S- 28, Sairrt Paul, Minnesota 55104
(651) 642-0800 T'fY/MRS 1-800-627-3529 www.electriciry.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION 0 REPAIR Describe -using the back of the white copy if nflcessary - the wak covered by this request:
VICES / POWER SUPPLIES
0 to 400 Ampere @ $25
401 to 800 Ampere @ $50
Above 8(10 Ampere @ $75
;UITS I FEEDERS
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus C� $.50
3 to 12 Units
OTHER ADDITIONAL FEES
Lighting Rehofit � $.25 per Fixture
Center Pivot Irriaation Boom CaD S40
Outdoor LighGng Standard @ $t
Traffic Sianal Standard C� $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTAL FEE I
(minimum total fee is $20) , �j(� �
� �] J
THISARFAFORINSPECiptUS lk�V'�
I hereby ceAify that I inspeded the electrical installation described herein on the dates sfated:
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i INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 I
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Kequest uate: Rough-in Inspection Required? ❑ Yes � Inspedion Other Than Rough-In: ❑Ready Now�Wlll Call
G:�•�... /� —� You must call the inspedor when ready! Date Ready:
/6
I certify that I am the�110ENSED CONTRACTOR � COMPANY ❑ OWNER and hereby request inspection of the electrical work at::
INSiRUGTONS ON BACK OF VELLOW COPY BOARD OF ELEC7RICRV COPY . E8-OODOlA-14 8.1�. 2002