P - 78686REQUEST FOR ELECTRICAL INSPECTION
1�/� ��� O Q� � Minnesota Board of Electricity
�+ �� V 1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
�,, (651) 642-0800 TTYIMRS 1-800-627-3529 w tricitystate.mn.us
ork covered b this re uest:
❑ NEW ❑ REMODEL ❑ ADDITION REPAIR Describe -using the back of ihe white copy if neces - 1' q
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ONE 8 TWO FAMILT UVVt�unoa, �nv� �..�
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspec6on Trips Each Dwelling Unit � 38�
CIRCUITS OF LESS THAN 50 VOLTS
fIFAMILY DWELUN�� rtn un� � (minimum total fee is 5n1) �'"' �'�"'—
3 t012 UnItS @$50 P2f U�it rNGS�qFpFORINSPELTdiU5E0KY
Each AddiGonal Unit @$25 I hereby certity that I iosD�d ���'^��0^ �"� �n on the dates sta�d:
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14308837
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COMPLETED WITHIN 12 MONTHS
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Request Date: Roughin Inspection Required? Yes No Inspection Other Than Rough-In: Ready Now O Will Call
S.3 �0 � You must call the inspeclor when readY! Date Ready:
I certi(y that I am the �I LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby �equest inspection of the electrical work at: