P - 76130REQUEST FOR ELECTRICAL INSPECTION
�� � 2 �' � � � � � Minnesota Board of Eledricity
1821 University Av S-128, Saint Paul, Minnesota 55104
(651)642-080 27-3529 www.edectricity.state.mn.us
Describe -using thPLbac�C the white coPY ff necessary - t�e vrork covered .
0 to
CIRCUITS OF LESS THAN 50 VOLTS
�stem Device or Apparetus (a� $.50
ADDRIONS TO THE GENERAL
3 to 12 Units
Trailsf6rtners u to 10 KVA $70
TransFormers over 10 KVA �$ 20
Transformer / Power Suppty for Signs / Outline LigMing $5
ONE & TWO FAMILY DWELLINGS, EACH UNR
Includes the Service and/or Power Supply up to 500 Amperes, M
Circufts and Two Inspecfion Trips Each DwelGng Unft (a� $8
TOTALFEE
total fee is $201
Z5 pBr FDRufe I hereby cettlfytl�at I irepeaed fhe electrical insfalla5on d�cn'hed herein an the detes �:
1 BOQrtI $40 ���" vre
Park Lots $25
Park Sites $5 �' - G� �T�
;�C.fion @ $20 ` �(�"Q�
LLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WRHIN
FOR UF:"ICE USE CN�Y
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1d1i' Rough-in Inspectlon Required7 ❑ Yes ❑ No Inspectlon Ofher Than Rough-In: Ready Now ❑YVN Cedl I
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��alJlLl �� You must cell the h�spedor when ready! Date Ready.
I certify that I am the I�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical wark at
Name
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DEPE�IDA�LE ELECTRIC, INC. �,� j�� pf, �� Ucense Num6er�
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WSTRUCTIONS ON BACK OF YqkbW PY BOARO OF ELEC7RICT' COPY �� EB-00001A-15 x 1 7�ma