P - 75671REQUEST FOR ELECTRICAL INSPECTION �
���� o�� �� � g121 Unive � A en e Su�S-128, Saint Paul, Minnesota 55104 f I
(651) 642-0800 TTY/MRS 1-500-627-3529 www.electriciry.state.mn.vs
be -us4�g theback of the white copy'rf necessary • the work covered by Uus request: J
1°�s'��cTi p�,N�.
GENERAL FEES Outdoor Lighting Standard $1
SERVICES / POWER SUPPLIES Traffic Signsl Standard @$5
Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCURS, CIRCUITS OF LESS THAN 50 VOLTS
Each S Device or A s@$.50
ADDITIONS TO THE GENERdL'.
3to12Unfls@
Each Addfional
Boom
ALLATION MAY BE ORD_E_RE[
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20605176
Transformers u to 10 KVA $10
Transformers over 10 KVA (a� $ ZO
Transformer / Power Suppiy for Signs / Otrtline Lighting @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Ir�cludes the Service andlor Power Supply up ro 500 Amperes, Au
Circuffs and Two Inspec.fion Trips Each Dwelr� Unit @$80
total fee is
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electrh�l h�afladon desvtbed herehi on the data staffid:
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��°,�1'�°"2 5 2001
' �7�01 �3�
Date: Rough-in Inspectlon Requ'ved7 ❑Yes p�o Inspedion OtherThan Rough-In: ❑ Ready Now�WUI Call
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You must cell the inspedor when readyl Date Ready.
I certify that I am the �JCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Addr�s �KY
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ConUador License Number Master Electridan or
�'�R�C 1NC C'�?�3�- �� N�,�
any or Owner Perfortnin9 InstaOaBon) 4 ��O'
o G 1 lE l fil �S /v1 tV
or Oxmer Perfomdng Installatlon) Please Provide Txro (2) Phone Number
�'7�6.3-78d� �