P - 78037REQUEST FOR ELECTRICAL INSPECTION
��- 5 4 4- 6 3 4�7 g�p� Unrv rsity Avenue 8uie te S- 28, Sair�t Paul. Minnesota 55104
,/ �d� (651)642-0800TTY/MRS1-800-627-3529www.electricity.state.mn.us
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❑ NEW aREMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERAL
SERVICES / POWER SUPPLIES
ALARM,
CIRCUITS OF LESS THAN 50 VOLTS
MULTIFAMILY DWELLINGS P( ER UNI,
3 to 12 Units @$50 Per Unit
Each Additional Unit @ b25
OTHER ADDITI01
Liah6na Retrofit 0 5.25 cer Fixture
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15446347
Su lemental Fee $20
Transformers u to 10 KVA $10
Trarisfomiers over 10 KVA $ 20
Tr�sfamer I Power Su fa S' ns I Outline L' htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Senice andlor Power Supply up to 500 Amperes, All
CircuiLs and Two Inspection Trips Each Dweliing Unit �$80
(minimum total fee is $20) � �(/'�'
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1 hereby cer6fy that I inspec�ed Ihe elecbical install�on deuribed herein on the dates sfaled:
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:CTED IF NOT COMPLETED VYITHIN 12 MONTHS
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KeQues[ ua[e: Roughin Inspection RequiredT LJ Yes �J No Inspedion Other Than Rough-In: ❑Ready Now�Will Call
/�i� ,�"�i� You must call the inspectar when ready! Date Ready:
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I ceAify that I am the �'L'LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe elee4ical wak at: