P - 787381�431-712 �7
, ❑ NEW ❑ REMODEL ❑
CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$� P� Unit
Each Additional Unit � $25
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY�MRS 1-800-627-3529 www•electriciry.state.mn.us
R Describe �usina the back of t�e white copy'rf necessar�}he work covere�by this request:
III�) IIII� II III �illl IIII� IIIII II II� II III �� I�
14317127
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I certi(y that I am the
ONE & TWO FAMILY DWELLINGS, �� u� �0 500 Am es, All
Includes the Service andlor Powe� Supply p P�
Circuits and Two Inspedion Trips Each Dwelling Unit �1580
(minimum total fee is $ZO) I (J�'�:/ J`�
TMS ARFA FOR kLSPECTpt USE ONLY
I hereby eerAfY Mat I inspec0ed IM electrical inspllation described herein on the d� sta�d:
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'e� j5�.��5�
Rough-in Inspection Required? ❑ Yes ❑ No Inspedion Other Than Rough-In: �eady Now ❑ VN�� Ce��
You must call the inspeclor when ready� Date Ready: /\
:NSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical worlc at:
BOARD OF ELECTRICIN CAPV
EB-00001M14 8.1.2002