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P - 78856REQUEST FOR ELECTRICAL INSPECTION 1�"r V f' - 2 6 7 9❑ Minnesota Board of Electricity 18 University Avenue Suite S-128, Saint Paul, Minnesota 55104 � 2-0800 TTY/MRS 1-800-627-352g www.electriciry.state.mn.us NEW ❑ REMODEL ❑ ADDITION 0 R IR cribe -using the back of the white copy if necessary - the work covered by this request: �� i: �n � o to 3to12 �MMUNICATION, REMOTE CONTRO! CIRCUITS OF LESS THAN 50 VOLTS $50 I illl il Iii II III I! NI il III II III il III II In �� I�. 14672679 0 ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes the Service and/or Power Supply up to 500 Amperes, AII Circuits and Two Inspection Trips Each Dwelling Unit �$80 TOTALFEE _ (minimum total fee is $20) p� Q r�ns a�n von uuaECroa usE orcr I herebY certify that I inspec(ed the electrical inspYaCpn desaibed herein on tlie da�s slaled: � �nnECrED IF NOT COMPLETED WITHII a�5 � 3 ��a Rough�n Inspection Required? ❑ Yes No �r�speUip� p�her Than Rough-In: Ready Now ❑ yNll Call � � 3 Vou must call the inspector when ready� Date Read Y I certfy�that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request ins pection of the electrical work at:: EB-00001A-14 8.1.2002