P - 78669REQUEST FOR ELECTRICAL INSPECTION
1��,Y Q� Q O� � Minnesota Board of Electricity -
`-h V V 1g21 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
� (651) 642-0800 TTY/MRS 1-800-627-3529 www•electricity.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION �REPAIR Describe -using the back of the white copy if necessary - the work cove�ed by this request:
ONE & TWO FAMILY DWELLIN�S, tnt;n um i
Includes ihe Service andlor Pwrer Supply up to 500 Amperes, NI
Grcuils and Two Inspec6on Trips Each Dwelling Unit � S80
CIRCUITS OF LESS THAN 50 VOLTS
FAMILY DWELLINGS (PER UNIn _ TOTAL FEE 4 O.�j O
ro 12 Units � S50 Per unit (minimum total fee is $20)
T�s u� wa.ar�c.ars u� o..
ach Additional Unit � E25 ��ppr ceNFi n� � i�peclea me ekcuical i�alabon aesaibea naein on me aabs sraba:
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( I��) �I III (I III I II� �� III �I I�) II III �� �� I�
144880L9 MAY191D���55
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Request Date: Rough-in Inspedion Required? gl Yes ❑ No I�peUion Otl�er Than I�ugh-In: ❑Ready Will CaN
5/ 16 / 0 3 v«, m�� �u � mso�c« �,n�, �ay� n� r�dr .
I certify tliat I am the C�I.ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby r¢quest inspedion of 1he �� wak at: