P - 78877�.-650-257 �
0
CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 U�its �$5p per
Each Additional Unit � 9
l i l l l I I I I I I� I I i l l l l! I I I I I I I I I I I l l l f I I I
II�I�'II�I
�
16502577
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electriaty
1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-352g www,¢[ectricity.state.mn.us
t Describe -using the back of the e 'rf necessary - the work covered by this request:
�- - - A - - -
ONE 8 TWO FAMILY DWELLINGS, EqCF{ UNIT
Includes the Service and/a Power SuPMY �P to 500 Amperes, All
Circuifs and Two Inspection 7ri� Each Dwellir�g Unit @ S80
(minimum total fee is $2p) � �Q -� `'
��
IherebycaMYtl�atli rHSU�wnrsrECroausEaar
�ed the electical insfaqa6p� described I�ertin on the daEes sfaled:
�-�az f.r 6!✓ S'f
�o�t c�r��v� c,s� c����r
���q �
$^
ReQuest Date: Rou hin I — L"� �� ol �� � `J Q• S�
J g �Pection Required?
es ❑ No Inspecyfp� OIMx Than R q i gM n: ❑ R e a d y I Call
~( ^�� You must c a l l t h e i n s
P e � t o r when readyl Date Ready;
I cerrfify lhat I am the �ENSED C O NTRACTOR ❑ COINPANY
� Y b s (�et eox. or ❑ OWNER and hereby r�Q�;,st insPection of tlie elactrical work at:
A (��°.��. �
,��, T�►� �-- �-L�(.,,�r � �-_.
a
_,
�e �o�ae Two c2� q,a„e ►,�m,�s�,�aua� a
� � �� � ��� -%y�� ( )
�����
�
' � �� �_�_Pawer umnec �
�,e. _ ._ . .. _
���(