P - 77151REQUEST FOR ELECTRICAL INSPECTION
1� 7 4 6-� 2 3� gp� Un� rs ri Avenue 3uie te S- 28, Saint Paul, Minnesota 55104
(651)642-08001TY/MRS 1-800�27-3529 www.electriciry.state.mn.us
❑ NEW O REMODEL ❑ ADDITION ❑ REP R Describe -using bxk of ihe white copy 'rf necessary - the work covered by this request:
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GENERAL FEES Outdoor Lighting Standard @ E1
CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Each Addi6onal Unit � $25
Center Pivot Irtigation Boom
Manufactured Home Park La
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Mile
AY BE ORDERED
Su lemental Fee 320
Transformers u to 10 KVA $10
Transfonners over 10 KVA $ 20
Transfortner I Power Su I for Si ns I Outline Li htin a5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @ S80
AddiGon� Ins don Tri E20
Investi ative Fee
Reins tion Fce E20
TOTALFEE
(minimum total fee is $20) C�
TMIS ARFA FOR INSPECTpi USE MY
I hereby ceAify tlwt I inspected Ihe electrical installaEon described herein on tlie dafes slaled:
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R� Dat Rough-in Inspeclion Required? ❑ Yes No Inspection Other Than Raugh-In: �Ready Now Wfll Call
D� You must call the inspector when ready! Date Ready. _
I oertiy that I am tt�e CENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request �spection of the elecUical work at:
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Section Township Range Fire No. Cou y
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°�` /Oaupant Name Please Provide Two (2) Phone Number(s) Indudirg Area Code
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ON BACK OF YELLOW G BOARD OF ELECTRICITV COPV E&00001M14 8.1. 2002