P - 75974REQUEST FOR ELECTRICAL INSPECTION '
�������� 0`� � 8'21 Un'�nrers� Ae n e Su�e S-� 8, Saint Paul, Mlnnesota 551D4 a- : I
�• (651) 642-0800 TTY/MRS 1-800-627-3529 www.edectricity.state.mn.us
Desaibe -using the back oF the white copy'rf n�sary - the work covered by this requ�t:
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GEN EES oor Li hting Sfandard @$1
SERVICES / POWER SUPPLIES w _ Traflic Sianal Standard C�D $5
0 to Z00 Am re $5 ONE 8 NJO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Ir�ctudes the Service and/or Power Supply up to 500 Amperes, M
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Ciratits and Twro Ir�sp�tion Trips Each Dwelling Unft Q$80
CIRCUITS, CIRCURS OF LESS THAN 50 VOLTS Additlonai Insuection Trius C�D $20
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tOtal f@B IS $20) I�/� Q��
Each Addfional Unit @ $25 19SPf�"F°f0'�''`�"g0"�
OTHER ADDRIONAL FEES
Lightlng Retrofit (� $25 per Fbdure I hereby cerdfy tl�et I 6� tlre etecMml I�talla8on desmbed here6i on tlre detes amo�i:
CeMer Pivot Irti ation Boom $40 R01°'�' °ATE
Menutactured Home Park Lots $25
Recrea6onal Vehicle Park Sites $5 �"`"�PEH"0N C�� A/�
Senarate Bomiirm I�oedian id �'10 ���---�-r p'' (¢••r�o
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FOR OFRCE USE ONLY
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�� Rough-in Inspe�on Requhed? ❑Yea �o Inspecdon OtherThan Rough-Ir��eady Now ❑Vllm Ca0
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I certify that I am the CEN&ED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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Please Provide Two ) Pho�re Numbe�s I
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:ompany Name Contrador Lh�nae Nwn6er Master Elerkidan or Power Ltmfted Tedmidan
I1wr� Number
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.� 1804 Freeman Pt Rd. Cromwell, MN 55726
(Conha _-- Pl�se Provide Two (2) Phorre Numbew Im�uding Area Cade
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