P - 78585REQUEST FOR ELECTRICAL INSPECTION
1, � 4 O�° 5 3 7�8 Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY�MRS 1-800-&27-3529 www•electricity.state.mn.us
❑ NEW ❑ REMODEL ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the wwk covered by this request:
CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Uniis �$50 Per Unit
Each Additional Unit � $25
II�II i) III IIIi� IIIII II III II IIl IIIII II III �� I�
1 4 0 7 5 3 7 8
20
ONE 8 TWO FAMILY DWt�urv�5, tn�n uni �
Includes the Service ariNor Power SuPP�Y �P � 5� �"P��'�I
Grcuits and Two Inspection Trips Each Dwelling UnN @ S80
(minimum botal fee is S20) � �'�r J V
M6 ME� FOR NSPECTdt USE OKV
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Request Date: Rough-in Inspedion Recluired? ❑ Yes Inspec�on OlFier Than Rou9Mn: ❑Rmdy Now �1MII Cal1
�/ �D J You must catl fhe f�pedor when ready� Date ReedY'
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