P - 78111REQUEST FOR ELECTRICAL INSPECTION
�� 5 2 6� V 1�� g�p� Unrv rsity Avenue 8uie te S- 28, Sairrt Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 7-800-627-3529 www.electricity.state.mn.us
❑ NEW REMODE�L ❑ ADDITI�' ❑�I ; NDasc� u'�the back��ite copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Li�htinp Standard .$1
SERVICES I POWER
2M, COMMUNICATION, REMOTE CONTROL,
:UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL F
TIFAMILY DWELLINGS (PER UNIn
3 to 12 Units @$50 Per Unit
E�h Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit � $.25 per Fi�ure
Center Pivot Irtiaation Boom � E40
II�II IIIII IIIII IIII� II�II II III III�� (IIII �� I�
15268733
TraRc Si�nal Standard
ONE & 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 FE; I � p� �'jQ
minimum total fee is $20 (J —
THIS NtEA Fpi INSPECiOR ISE OtIV
I hereby cerGy Mat I inspecfed the electrical irniallation desc�ibed herein on fhe da�s sfated:
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Requ� u�e: Rough�n InspeGion Required? ❑ Yes No Inspection pther Than Rough-In: ❑Ready Now VNII Call
1' 'g �' � y You must call the inspector when ready! Date Ready:
I certify ttiat I am the �QLICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecfion of fhe electrica� wprk at:
-' "---•' ^' • wivui K cLCli I rtltil I�[:(ri'T E&000p1M14 8.1. 2002