P - 75918REQUEST FOR ELECTRICAL INSPECTION
���`° ���� � 1n821 Univers�Aven e 3uRe S- 28, Saint Paul, Minne�ta 55104
(651) 642-0800 TIY/MR51-800-627-3529 www.edectricity.stade.rrm.us
Qascribe -using the back of the white copy if necessary - the arork covered by s request: j,¢��u. Ge f— J
��T�G2 �r1�G Q�`TORArTieA� �
GENERAL FEES Outdoor LiaMina Standard al� $9
Above Z00 Am ere a$10
ALARM, COMMUNICATION; REMOTE CONTROL, SIG
CIRCURS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or s@$.50
ADDI170NS TO THE GENERAL FEES
3 to 12 Unfls @$50 Per Unit
Each Addfional Unit Ca� $25
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8E ORQERED
I IUI U UI I� III u lu �� lu � IU � u) I) I� �� I�
19635028
ONE 8 iW0 FAMILY DYdELLINGS, EACH UNIT
Includ� the Service aridlor Power Suppiy up to 500 Amperes, M
Cirarits and Two Inspection Trips Each DwelGr�g Unit �$80
Addfional Ins 'on Tri $20
Inv�gative Fee
Reins 'on Fee $20
TOTALFEE p [/� �
(minimum total fee is $20) 'TV o
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I hareby �tify tlret I Ir�Cted tlre electrical insteVadon d�afl�ed herein cn fhe da� s�ted:
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12 MONTHS
FOR OFFICE USE ONLY � � � �, /�
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I"�/ / /�+ I Rough-!n Inspectlon RequfredT �es ❑ No I Inspectlon Other Then Rough-In: O Ready Now �(V� Ca0
7 �^� You mus[ caA the inspector when ready! Date Ready. `
I c�rtify that I am the CENSED CONTRACTOR ❑ COMPANY ❑ OWNER arM hereby request inspection of the electrical work at
Job Site Street Address C
6 50 -°7�I►� St N E �R ��
T . Sectlon Ranae Fire Na t`.�umhr
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Owner PeAom�tng In
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MSTRUC710N3 ON 811CK OF YELLOW COPY HOARD OF ELECTRICIIY COPY
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�Numbar� Master Electridan or Prnxer Limk� Terhnic(an
3 ucerree Wiunber
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Please Provid�Two (2) Pha e�N� rs Including Area Code
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