P - 80578, ' REQUEST FOR ELECTRICALINSPECTION
Minnesota Board of Electricity
1-380-309 � 1821 Universiry Avenue Suite 5-128, Saint Paul, Minnesota 55104
(657)642-0800 TTYJMRS 7-800-627-3529
www. elechicity. s ta te. mn. us
� IdeMity the work coveretl by this request:
IAIARM, COMMUNICATION, REMOTE CONTROL.
CIRCWTS. CIRCWTS OF LESS THAN 50 VOLTS
I IIIIII II�I �III IIIII �III�NwII IMNN � II INI
" 1 3 8 0 3 0 9 3'
oNE a
Atltlitional
90�GMIrv
FlIULINSPEpiqN
EACH UNIT
�pDly up to 500 Amperes. All
Each Dwelling UnA � S8D
op
TOTALFEE
minimum totalfee is $20)
29o5a
� �����a, o� de�,b.d �are�� o� ,�a �,� _
'
% ���
FOP OFFICE USE ONLY
v�� i ��o�a
aa,s�
Now
I� nan �m� � �ou mus[ call [he inspec�or when reatly� I D t R dy I
I certity that I am the Ii� LICENSED CANTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspectlon of the elecirical work at