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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 $20) � a� r nas �FEn:at u15PECtat usE orar I hereby cer6ry that I inspec0ed the elecbical insfalla6on described herein on the dales sWBed: �.�� ,�-����'9 o20•S d `•°'+""` ""o. Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: Ready Now � Will Call 4?-03 You must call the inspecta when ready! Date Ready I certi(y that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe electrica� work at; �O�' °`{'� (�' ��° Route NoJ ��n, i�._ ,._._ KOVAR ELECTRIC 23049 ARROWHEAD ST NW S'I' FRANCIS MN 55470 �NS7RtICTiW1$ 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