P - 78176REQUEST FOR ELECTRICAL INSPECTION
�� J��- 813 ❑7 gy� � e�, A enue 8ui�S- 28, Sairrt Paul, Minnesota 55104
� (651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION p REPA�R Describe -using the back of the white copy rf necessary - the wqrk cover� by this request:
GENERALFEES
I POWER SUPPLIES
CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units �,1$50 Per Unit
Each Additional Unit � 5z5
LighGng Rehofit @ E.25 per Fixture
Center Pivot Imaation Boom � S4d
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ONE & 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
Reins tion Fee $
� TOTAL FEE �.— �
(minimum total fee is $20) � �,. `
THI$ AREA Fqt NISPECTpi USE pLY
I hereby cer6y tliffi I inspec0ed the dectrical installa0on despibed herein on the d�s st�ed:
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� THIS INSTALLATION MAY BE �RDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS ��
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15448137
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�' /.� Rough-in Inspection Required? ❑ Yes �No InspeGion Other Than Rough-In: ❑Ready Nar$ Will Call
��— V Yau must call the inspedor when readyl pe(e Ready.
I cerMy that 1 am the �'LICENSED CONTRACTOR ❑COMPANY ❑ OWNER and he�eby request inspec�on of the electriral work at: