P - 75816REQUEST FOR ELECTRICAL INSPE 10 0
I 1���£� - 3 6 5 0 Minnesota Board of Electricity ;�QD� ���v
ii 1821 University Avenue Suite S-128, Saint Paul, Minnesota 551 U4
(651) 642-0800 TTY/MRS 1�00-627-3529 www.edectricity.state.mn.us
D�saibe -usin9 the back of vrh�e y if necessary - the wark coyered by thi requ�t:
/POWER
� CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
� Each System Device or Apparatus �$.50
ADDI770NS TO THE GENERAL FEES
3 W 12 Units @$50 Per Unit
Each Additional UnR @ $25
OTHER AD
Li9htina Retrofit na $.25 oer f
5 �ial inspectlon @ $30 �er Hour
S' Ir�s on � g.37 r Mile
THIS INSTALLATION MAY BE ORDERED DI
I llil II III II I�( � I�I 111II II 111 II III II II I n l� I I�
18783654
Standard
TransFormer / Power Su I for Si rrs / OuUine Li ' $5
ONE 8 NVO FAMILY DWELLINGS, EACH UNff
Includes the Service andlor Power Supply up to 500 Amperes, AII
Circuits and Two Inspectlon Trips Each Dwelling Unft @$80
Additlonal Ins 'on Tri $ZO
Investigative Fee
Reins 'on Fee $20
TOTALFEE
(minimum total fee is $20) .��
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I hereby t�itify that I inspeded Ure electrical U�adon d�crtl�ed herein on fhe dates stat�:
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3 E �C �
COMPLETED WITF
�Or? Of"�CE USE CNiY
�' Rough-InlnspectlonR uired� ❑Y� ❑No Ins
eq p�lion Other Than Rough-Irc Ready Now ❑ Wi� Call
A��` �� You must call the inspector when ready! Date Ready.
I certify that I am the I�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER .and hereby request inspection of the electrical work at
I DEPENDABLE ELECTRIC, INC.
or
���r /Z�� �
we Numt�r Master Electrician or P
4 ♦ S / License Numbern _n,
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