P - 77022REQUEST FOR ELECTRIC . L IANSPECT ON
1��� 1- 7 9 6� 821 �Unrv rs� Avenue Suie teS- 28, Sa�Ov�nesota� �04 f
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
❑ NEW ❑ REMODEL O ADDITION EPAIR Describe -using the back of Me white copy if necessary - the wo� covered by this request:
GENERAL
401 to
ALARM, COMMUNICATION, REMOTE WNTROI
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
MULTIFAMILY DWELLINGS PEI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
Lighting Retrofit � $.25 per Fi�
Center Pivot Irtiga6on Boom �
Manufactured Home Park Lots
Recreational Vehicle Park Site
Hour
Mile
ORDERED DISI
I�� �I �� II III II III II III II ��I II III I� �II �� I�
L4317960
Transfomiers
ONE � TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Cirouits and Two Inspection Trips Exh Dwelling Unit @$80
Reins 6on Fee $20
TOTALFEE
(minimum total fee is $20) � �
TNIS�REAFORINSPECi0RU5E0PAV b
I hereby certify that I inspected the elettrical insfallffion described herein on the dales staled:
�
Request Date: Rough-in Inspeclion Required? ❑ Yes �NO Inspection Other Than Rough-In: �teady Now LJ Will Call
%a� — Q� Yar must call the inspecta when ready! Date Ready: _��r �
I certiy �at I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: