P - 788571-46s0-164 �
j�-�tS�1�
❑ NEW MODEL ❑ ADDITION ❑
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Aoo�atus � 5.50
3 to 12 Units @$50 Per Unit
Each Additional Unit � S25
IIIII IIIII II�I� IIIII III�I II I� �III� IIIII �� I�
14601645
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
� Descnbe -using the back of the white copy d necessary - the work covered by this request:
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Grcuits and Two Inspection Trips Each Dwelling Unit @$60
TOTAL FEE ��
(minimum total fee � $20) p2 � �
TM$ NtEA FOR ttbPECiOR USE OKY
I hereby c�r6fy that I inspected the elecbic� insfaU�on �scribed herein on tl�e da0es slaled:
�� 1
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u �vmrHrv r u UwNER and hereby reyuest mspection ��e e�� � a�:
INS7RUC710N8 ON BACK OF �ELLOW COP1/
BOARD OF ELECTRICITV COPY -— _ �_'v �_
F9-00001A-14 8.1. ZOp2