P - 787771-�4-8�-3�6 �
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❑ NEW REMODEL ❑ ADDITION ❑ i
CIRCUITS OF LESS THAN 50 VOLTS
to 12 Units �? $50 Per
I IIII II III II III I� III I� III II III� �I III II III u I� I��I
L4873863
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity _
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0800TTY/MRS 7-800�27-3529 www,electricity.state.mn.us
� Describe -using the back f the white copy'rf necessary - the work covered by this request:
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ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes fhe Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$60
TOTAL FEE I pZ ��—
(minimum total fee is $20)
TWS RFEA Fpi RN'ECTpt {15E qdY
I hereby cer5(y tl�at I inspected the elecbcal inspllation �scribed herein an the daffis st�ed:
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l� ypa/ �5� so
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nuuy���n mspecuon rteqwretl7 LJ Yes Inspection Other Than Rough-In: �Ready N Will Call
�� 1� �� You must call the inspectw when ready! pete Read
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I certify lhat I am the ENSED CONTRACTOR ❑ COMPANY ❑ OWNER ar�d hereby request inspection of 1he electrica� work at:
.bn sne Nad�ss (so-�. eox a� nb.> cny Z code
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�hae Two (z) ano�e �am,ber(s
1l'��57 � �
�a.+ rrecmraan or
O� � —1 b License Number
ON BACK OF YE OF EIECTRICITV COPY
E9-OOOD1M74 8.1.2002