P - 75814iREQUEST FOR ELECTRIC L INSPEC Nr�� ��'
� � �'� � � 4 � 4 � Minnesota Board of Etectricity ����J
1821 Universiiy Avenue Suite S-128, aint Paul, innesota 55104
(651) fi42-O800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
I D�cnbe -usir�g tlre back of the whde copy iF necessary - the work covered by this request: I
5/FEEDERS
Z00 Am�re @ $5
ve 200 Ampere @$10
�MMUNICATION, REMOTE CONTROI
5, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units
Home
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18204842
ONE 8 TWO FAMILY DWELLINGS, EACH UNff
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuifs and Two Inspection Trips Each Dweiling Unit @$60
Additional Inspection Trips @ $20
Im�estltlnaUve Fee
�o�ni.r� �
total f� is $20) f �3 �
I hereblr certlty tl�at I 6�spec� uie elec6ical h�amuat�n descnbed Irere6� on tlre
VIPLETED WITHIN 12
FOP.O=F�CE USE QtJLY
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Rough-In Inspectlon Requiredl �.Yea ❑ No Inspection Other Than Rough-In: � Ready Now 0 WN CaII
� ��� L/ You must call the inspectur when readyl Date Ready: � �� � j D��
I certify that I am the p LICENSED CONTRACTOR ❑ COMPANY '� OWNER and hereby request inspection of the electrical work afi
Job Site Streat Addr�s � ��y
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Master Electrician or
Ucense Number
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