P - 75681REQIJEST FOR ELECTRICAL INSPECTION
� � � � � � 4 4 � � ��nnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minrresota 55104
- � (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.sdate.mn.us
Df�"be -using the t�rdc of white copy ff n�essary - the arork covered by this requ�t:
/ �fA L(� � Le / % G� � �
GENERAL FEES Outdoor Liahtina dard na. $1
0 to 400
CIRCUITS OF LESS THAN 50 VOLTS
ADDITIONS TO THE
Home Park Lots
Transfortners over 10 KVA $ 20
Transformer I Power Su I for Si r�s / Outlirte Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Cirarits and Two Inspection Trips Dw �' Unit @$80
Additional Ins 'on Tri $20
Investl ' Fee �
Reins 'on Fee $20
TOTAL FEE
(minimum total fee is $20) /
n� nrsen Foa n�cr� usE ow.r
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I herebvi ceNfv tlmt I in�eded itre elec6ical fnata0atlun desrnbed hereN on tlre dates ateted:
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT C�MPLETED WITHIN 12 MONTH
FOR OFFICE USE ONLY
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2 1 2 3 4 4 5 5 �p�y`���%�j
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�� � I Rough-In Inspectlon R�uhed? ❑Yes �o I Inspe�on OtherThen Rough-In�Ready Now �VViO Ca0
�� � You must ceA the inspec[or when readyl Date Ready:
I certiiy that I am the CENSED COMRACTQR ❑ COMPANY 0 OWNER and hereby request inspection of the electrical work at
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c:ormacmr ucense rvumner masasr rrecmcian or rower um¢ea i ecnrt
Llcenae Number
Sprinter `=lectrical Services CA03969 AM00878
2525 Ne���ada Ave N#203, Golden Valley MN 55427
Phone 753-546-8060 Fax 763-546-8084