P - 75877REQUEST FOR ELECTRICAL INSPECTION
I � � � � � �'� � 6 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Sahrt Paul, Minnesoffi 55104
(659) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using bac(c white copy'rf ne�sary - tt� wgrk red by this re�lu�t:
SUPPLIES
0 to 400
CIRCURS OF LESS THAN � VOLTS
ivstem Device or Aooaratus l�d $.50
@
� Retrafrt V 5.7.5 per FixtUi@
Pivot Irtinatlon Boom (a� $40
Tra�c Si nal Standard Q$5
Su lemental Fee @ $20
Tra�sFormers u to 10 KVA (�D $10
Transformers over 10 KVA $ 2f1
Traristormer / Power Su I tor Si ns / Outiirre Li hd $5
ONE & TWO FAMILY DWELLINGS, EACH UNR
Includ� the Service andlor Pawer Suppty up to 500 Amperes, A�
Cirarits and Two Inspection Trips Each DweIGm3 Unit (a3 $8
Additional Irrs e�on Tri s$20
InvestlqaUve Fee
Rems ection F� $20
TOTALFEE
(minimum total fee is $20) s e
' THISAREAFOR Qd9PECTOR USE WLLY
I herebY �YNat I tr�ed tlre electrical 6�siaVatlon des�bed herain on I
►LLATION MAY BE ORDERED DISCONNECTED
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�' Rough-ininspectlon uhed? ❑Yes ❑No I
Rep nspectlon Ofher Than Raigh-In: eady Now ❑VHm Cetl
'�� You must cap the inspedor when readyl Date R�ly.
f certify that I am lhe� CENSED CONTRACTOR ❑ COMPANY ❑ OWNER artd hereby re�}uest inspectiort of the elecfical arork at
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�DEPENDABLE ELECTRtC, INC.
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Lioer�se Number
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