P - 75975REQUEST FOR ELECTRICAL INSPECTION
I 2��� 7�� 9 7 � Minne Board of Electricity �-
182 nive Avenue Suite S-128, Saint Paul, Minnesota 55104
� (65 )� OTTY/MRS 1-800-627-3529 www.elecfricity.state.mn.us
D�scribe -usi e back�3f the whfte,koov ff ris- work ered 6v t�' r�uesr
to
3 to
SUPPLIES
CIRCUITS OF LESS THAN 50 VOLTS
@ $25
iER ADDITIOI
25 per FoRure
� Boom a(� $�1C
�I U III I) �� II III II �� II ��I II t�l �I I� �� I�
20270971
Outd�r Lighting Standard @
Tra(fic S' nal Standard $
Sup demental Fee @ $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su for Si �/ Outline U hUn $5
ONE & TVdO FAMILY DWELLINGS, EACH UNR
Includes the Service andlor Power Supply up to 500 Amper�, All
Cir�wits and Two Inspection Trips Each Dwelling Unit @$80
(minimum total fee is
nnsa�aw
I heretry certKy fhet I�ed tlre etectrical
�w
wxsum�cnon
�_��—�
o�mmiasu,mor�u
ICTED IF NOT COMPLETE
d�d herain on ths dates stated:
��
� � �� � QG
�re
i1N 12 MONTHS
FOR iiF�(CE USE GNL'f
���� �� �����
Rough-InlnspedionRequired7 ❑Y� ❑Ido InspecBonOtherThanRough-In: ReadyNowOWlpCall
�/' �� You must ca0 the inspector when ready! Date Ready,
I certiiy thffi I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electricxl w+ork afi
Job Site Street Add -
c r � s � . • w ' � C� � aA
DEPENDG�LE ELECTRIC, INC.
` �/� � L�VA � �
ise Num6er MasUer Electridan or
� u� N��,
Please Provkle Two (2) Phone Number:
������ S�