P - 78675�:. 7��"�07 ,
❑ REMODEL ❑
0
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus kil S 50
550 Per Unit
Unit � $25
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electriciry - �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
FS51) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us �
J
2� Descnbe -using the back of the white copy if necessary - the work covered by this requesl: �
,pection @ $.31 per Mile
4LLATION MAY BE ORDERE�
�i�l I! III II Ill li �l II �I II III II �I I I III II I� I INI
L7�!40071
Outdoor
Fee�
1D �0
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspec6on Trips Each Dwelling Unit �$80
(minimum total fee is $20) � a� r
nas �FEn:at u15PECtat usE orar
I hereby cer6ry that I inspec0ed the elecbical insfalla6on described herein on the dales sWBed:
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,�-����'9
o20•S d
`•°'+""` ""o. Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: Ready Now � Will Call
4?-03 You must call the inspecta when ready! Date Ready
I certi(y that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe electrica� work at;
�O�' °`{'� (�' ��° Route NoJ ��n, i�._ ,._._
KOVAR ELECTRIC
23049 ARROWHEAD ST NW S'I' FRANCIS MN 55470
�NS7RtICTiW1$ ON BACK OF YE�IAI COPY � BOARp OF ELECTRICITV COPy
mas[er r�ew�an a
License Number
763-753-5731
EB-00001Mi4 BA.2002