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P - 787231-416-834� O NEW ❑ REMODE ADDITION ❑ � . GENERALFEES IMMUNICATION, REMOTE CANTROL, CIRCUITS OF LESS THAN 50 VOLTS 3 M 12 Units �$50 Per Each Additional Unit @ ; REQUEST FOR ELECTRICAL INSPECTION Minnesota Board of Electricity � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 (651) 642-0800 TfY/MRS 1-800�27-3529 www•electricity.state.mn.us R Describe�using the back of the white copy i necessary - the work covered by this request r Liahtina Standard �D. $1 ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes ihe Service �dlor Paxer Supply up to 500 Amperes, All Cirouils and Two Inspection Trips Each Dwelling Unit �$80 TOTAL FEE D '�i (minimum total fee is $20) T1tl5 MEA Gpt �6PECTOR USE OILY I hereby cer6fy tlwt I insp�ed tlie elechica� lnstalla6on described herein ai Me daBes stffied: 0 "'���. C I llll ll l ll l l ll l l l l l l il lll l l l ll l l lil ll l ll !I �I I�II 1 4 1 6 8 3 4 8 �1/�17/,�- �p,,�� Request Date: Rough-in tr�sPedion Required? ❑ No Inspedion Olher Then RauglNn: OReady Now VWII Call ���4 You must mll the inspedor wh� readyl Date R�dy. . J cerMy that I am the �LICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request i�spection � Itl�e elecUical wwk at: Job Site Address (Street Box. a Route No.1 _ Cilv i' _ ��8 0225 � � o� !i��l,/. .� _ «Tir��'� �.,...�. - �� , ��ol 7�7 EB-00001M11 8A. 2002