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:UITS /
� REQUEST FOR ELECTRICAL INSPECTION
5 6 ard of Electricity
Avenue Suite 5-128, Saint Paul, Minnesota 55104
00 TTYlMRS 1-800-627-3529 electr' iry tat
d the white py n�sary -�the wqrk covered by this request:
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GENERAL ES Outdoor Liahting Standard @$1
)MMUNICATION, REMOTE CONTROL,
CIRCURS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Pe
Each Addi6onal Unit @
III� ulll II�I II�II �III IIIII II III IIIII �� I�
2Q635561
ONE 8 Nd0 FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each DwelGng Unit @$80
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a::�:rt.
n�F� ���DO
is $201
I hereby certib that I fnspeded ttre electrical iretalladon des�ed herem on fhe dates steted:
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�� Rough-in Inspecdon Required7 ❑Yes o Inspectlon OtherThan Rough-In: � Ready N� Ca0
�• O� D� �� You must call the inspedor when readyl Date Ready:
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby r�uest inspection of the electrical work at
Job Site Street Addre �h11
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Tovmship Sedion Renge Fire No. Cou
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ptimer/omroant Name� Piease Provide Two (2) Phorre Numbera Including Area Code
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Electrical UUlity Electricel Utll'�Address
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Contractor / Company Name CoMrador License Number Master ElecLidan or Power Llmi[ed Techn�
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Mailing Addr�s (Contrador Cympany or Owner Pertortning I on) �� ��/ �
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Authoriaed Sfg�re (Contractor or Owner erforming Instellation) Please Provide Two (2) Phone Numbers Including Area Code
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