P - 77668REQUEST FOR ELECTRICAL �IN,�SP�C�TI��j
1—��� �� � 821 Unrversity Avenue 8u�S-128, Sairrt�a M nnesota 55104��
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, � (651)642-0800mlMRS1�00-627-3529www.electriciry.stote.mn.us
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n0 NEW ❑ REMODEL ❑ ADDITION REPAIR Desaibe -using the badc of tl�e white copy 'rf necessary - Me work covered by this request:
1�2�U� l r� 1 U i�.iY 1 i. �"�Q ,( \)1 /' D i�/i lil(1('� 0%� �(l� e�1'i��( M
IMMUNICATION, REMOTE CONTROI
CIRCUITS OF LESS THAN 50 VOLTS
Svstem Device or Aooaralus � f.50
3 to 12 Units
Exh Additia
Lghting Retrofit
Center Pivot IrtN
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Iln IIIII IIIII IIIII I(III IIIII IIIiI IIIII p� I�
16418774
� Transfortners up to 10 KVA @ E10
� Tr�sfomiers over 10 KVA Q S 20
Transfomier I Power Supply fa Signs / Outline Lqhtinn ES
ONE 8 TWO FAMILY DWELIINGS, EACH UNIT
Includes the Service andla Power Supply up to 500 Amperes, All
CircuiLs and Two Inspection Trips Exh Dwelling Unit @ S80
Additior�al Inspection Trips @ S20
Investioative Fee
(minimum total fee is $20) �
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I herebr arffy tliel I i�pa,Yed tlie ekcYical i�taYa6on
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•�w� �e: I Rougnin �ropeaion Requirea? u res �No Ins
pection OtherThan RougMn: Now Wfll Call
�' V�p tQ� You must call the inspecln wAen readyl pete Ready
I certify ihat I am the �LICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of Ihe electrical work at:
Job Site Address iStree6 aox. a Roule No.) Zp Code
222 n� la �� c�- G'�'r � b�e�� S��R 32
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E&OOD01M14 BA.2002
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