P - 76329REQUEST FOR ELECTRICAL INSPECTION
� � � � � � ° � � 8121 Unroersity AvenueESuRe S � 8, Saint Paul, Minnesota 55104 +�
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -usir�g the of the white copy'rf necessary - the work covered by this reque,st:
GENERAL FEES i Outdoor Liahtina Standard (d $1
401 to 8(10
Above B00
CIRCUITS OF LESS THAN 50 VOLTS
iystem Device ar Apparatus @ $.50
ADDITIONS TO THE GENERAL fEES
I Ilu 4 UI II �� I�� II �II II I� II �I II I� �� I�
�0752499
Transfortners up to 10 KVA @$10
Transformsrs over 10 KVA Ca? $ 20
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$BO
Fee @ $20
TOTAI
iimum total fee is
I herebvi cetWv thst I hreoected the electricel (r�tallatlon desaibed herefn on Ute dates ateted: I
F� OFFICE USE Oh:.'r
I�CD MAY -1200i'
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��� Rough-in Inspecdon Required7 ❑ Y� �JVo Inspectlon Other Then Rough-in: 0 Ready Naw �YUm CaA
i You must call the inspedor when readyt Date Ready:
I cefify that i am the � LICENSED CONTRACTOR � COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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, Company or
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mascer tiecmc�an or
Li�nse Number