P - 78018REQUEST FOR ELECTRICAL INSPECTION
1���r.J �- 7 2 9 1� 182� Un� ersity Ae nue Su�S- 28, Sairrt Paul, Minnesota 55104
,� ���$ (651)642-0800TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
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NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back M the white copy ff necessary - ihe work covered by this request:
FEES
401 to
Above
GRCUITS I
0 to 20
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @ S•50
ADDITIONS TO THE GENERAL
Per Und
ADDITIONAL FEES
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L5637291
Traffic
Fce
ONE & TWO FAMILY DWELLJNGS, EACH UNIT
Includes ihe Service anNor Power Supply up to 500 Amperes, All
Circuils and Two Inspection Trips Each Dwellirg Unit @ E�
iuin�rtt ��
(minimum total fee is $20) C7�7, �0
r'es uu� wrs rcs�cTOn us� aar
I I�ereby cd6fy tliat I inspecled tlie �al insfallation daaibed IKrdn on tlie
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S ��il
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�� �� Roughin Inspedion Required? LJ Yes � Irspedion Other Than RougMn: ❑Ready Now�VWl Call
' a, "� `'03 You must call the inspector when ready! pe(e R�dy: .
I certify U�at I am the � LICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby req�st inspection of Ihe electricai work at: