P - 80576' REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1-377-472 � 1821 University Avenue Suite 5-128, Sainf Paul, Minnesota 55104
(651) 642-0800 TTVIMRS 1-800-627-3529
www.electncity.state.mn.us .
� Itlentitythe woM covered by
qRCUITS OF LESS THAN 50 VOL
illlll,�ll nln Nlil III �N�Il�IIII II
�I UOlLM/U"I � You must call iM1e inspecror w
I certiy that I am the � LICENSED CONTRACTOR ❑
Job Atltlress �Street. Bax, or Route No.l
ONE 8 N10 FAMILY DWELLMGS EACH UNIT
Indudes the Service andlor Power Supply up to 500 Amperes, All
CircuAS and Two Inspection Trips Each Dwelling Unit �$80
TOTALFEE
29050
i naren. ce�crv mau wnemea me e�emm� mnauatio� aesenoeo eerem o� me m�as �eiem
Z- 1z
FOH OFFICE USE ONLV
�a- �r2905�0.so
antl here6y
�����G�
or Owner Pertarming InsFellafion)
BOARD OF ELECTRICITY COPV
of ihe electnCal work at: