P - 75863REQUEST FOR ELECTRICAL INSPECTION
1� V� 0� 410 0 g121 Unive � A en e 3u�S- 28, Saint Paul, Minnesota 55104
(651) 642-OS00 TTY/MRS 1-800-627-3529 www.edectricity.state.mn.us ��" "�
Describe -using the back�Df the white copy'rf necessary - the vrork covered by this request:
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ALARM, COMMUNICATION, REMOTE COPITROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S m Device or A ratus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS ER UNI
3 to 12 Unfts @$50 Per Unft
Each Addfional Un(t � $25
OTHER ADDITIONAL FEES
Li htin Retrofrt @$25 r Focture
Cemer Pivot Irtigation Boom @ $40
Manufaclured Home Park Lots $25
Recreatlonal Vehicle Park S'des $5
Se rate Bondin Ins on $20
S ' Ins 'on $30 r Hour
S' Ins on .31 r Mile
'� THIS INSTALLATION MAY BE ORDERED DI
I���I Illu �41 ��II III� �II��� II� �� I�
182041�7
Traffic
Includes the Service andlor Power Supply up to 5U0 Amperes, A�
Cirarits and Two InspeCtion Trips Each Dwelling Unit @$80
Add'fiornal Inspecfion Tdps @ $20
Im�stlaative F�
total fee is $201 I od !�
I herehy cerU(Y that I i�peded the electrical �ta0atlon desai6ed f�erein on tlre dates atffied: I
FOR UFFICE L}SE Otv:. �
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��� Rough-in Inspection RequU�i1 ❑Yes ❑No Inspectlon OtherThan Rough-In: ❑ Ready Now OWiA CaA
�^�Y �D � You must cell the Inapector when readyl Date Ready.
I certify that I am the ❑ UCENSED CONTRACTOR ❑ COMPANY �AWNER and hereby request inspe�ion of the el�rical work at
Job S(te Street Addr�s City
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� Provide Two (2) Phorre Numbers Including Area
) �g3-�919 ��b3)-aa9-�
mber Master Dectridan or Power Lfmlted 1
Li�r�se Number
� Provide Two (Z) Phone Numbers Indumrtg Area
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