P - 75748REQUEST FOR ELECTRICAL INSPECTION
1- 5 7 3- 015 � 82; University A en e S�S-128, �;� �w, �;� �, �
(651) 642-0800 T1Y/MRS 1-800-627-3529 www.electricity.stnte.mn.us
❑ NEW ❑ RE�WODEL ❑ ADDITION REPAIR Describe -usir� the back of the white copyr�f n�ssary - the work covered by th� �equ�
SERVICES /
iM, COMMUNICATION, REMOTE CONTROL, SIGNFWNG
;URS, CIRCUITS OF LESS THAN 50 VOLTS
E�h System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
fIFAMILY OWEWNGS PER UN
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
� Retrofit @ $.25 per Fudure
Pivot Irriaafion Boom (� S4L
III� UIII II�II IIII� I�III IIIII (IIII �IIII u� I�
15730153
Fee
ONE & TWO FAMILY DWEW NGS, EACH UNIT
Includ� the Service and/or Power Supply up to 500 Amper�s, All
CircuiLs and Two Inspection Trips Exh DxrelGng Unit @$BO
TOTAL FEE �
(minimum total fee is $20)
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I hereby tertify tl�at I inspected tf�e eleetrical ir�on described he�em on the dat� sta�d:
F� � 1�
Hequ�t Rough-in Inspectlan Required7 ❑ Y� No IrLSpection Other Then RougtNn: �Ready Now Wfill Cell
6 Yau must call Ure Mspedor when readyl �te Reydy.
I certify tliat am LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby �uest mspection of tt�e electrical work at:
Job Site Address iStreet, B x, or Roufe Itlo.) Zip Code
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