P - 75972REQUEST FOR ELECTRICAL INSPECTION �'
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9821 University A ' e 128, Sairrt Paul, Minnesota 55104
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(651) 642-0800 -800-627-3529 www.edecJricity.state.mrr.us
D�cribe -using the back of ite copy'rf necessery - the work�°/ver� by this�N
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401 to 800
Above 800
)MMUNICATION, REMOTE COMROL,
CIRCUITS OF LESS THAN 50 VOLTS
iystem Device or Apparatus @ $.50
ADDITIdNS TO THE GENERAL FI
3 to 12 Units
Home Park Lots
'ehicle Park Sit�
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Trarrcformer I Power Supply for Signs / Outline htlng $5
ONE & TWO FAMILY DVdELLINGS, EACH UNIT
Ir�cludes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each DwelGrtg Unit @$BO
total fee is
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� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
FUR QFFICE itSE ONLY
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��' Rough-in Inspectlon Requiredl ❑Yes ❑No InspecUon Other Than Rough-In: Ready Now �Wi� Cell
����C-� You must call the inspector when ready! Date Ready.
I certify that I am the UCENSED COMRACTOR 0 COMPANY ❑ OWNER arM hereby request inspedion of the electrical work at
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License Number /1
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