P - 76599REQUEST FOR ELECTRICAL INSPECTION
1� 511 � J v� � gp� Unrve 'ty Aven 8ue te S- 28, Saird Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW REMODEL ❑ ADDITION 0 REPAIR Describe -using the back of the white copy'rf necessary - the woric covered by this request:
Fi,v $AS£r�1�NT �SgreuicF v�y2Qor To :Zan A.a�v'
GENERAL FEES Outdoor Liahtina Standard �$1
0 to 400
U_
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALIN�
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to t2 Units @$50 Pe
Each Additional Unit @
Center Pivot IrrigaGon Boom
Manufactured Home Pak Lc
Recreational Vehicle Pak S�'
$� �f HOUf
5.31 cer Mile
IIII IIIiI IIIII IIIII IIIII IINI IIIII IIIII N� i�i
15119829
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Senice andlor Power Supply up to 500 Amperes, All
Circuits and Two inspec6on Trips Exh Dwelling Unit �$60
Investi ative Fee
Reins tion Fee $20
TOTAL FEE `� SC
(minimum total fee is $20) a v. ��
TH45 MFA FIXi INSPECTOR USE plv
I hereby cer6y that I inspecEed Ihe electrical installation described herein on the dates sfa0ed:
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COMPLETED WITHIN 12 MONTHS
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Kequest uate: Rough-in Inspection Required? ��Yes U No Inspedion Olher Than Rough-In: �eady Now LJ WNI Call �
/a - 3/ - U�j You must call the inspeda when ready! Date Ready. LQ _�� _�
I certi(y that I am tlie �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tl�e electrical work at: