P - 78992REQUEST FOR ELECTRICAL INSPECTION -
�— q, � O�� 7 O 2 Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 -:
� � �,a �'��651) 642-0800 TTY/MRS 1-800�27-3529 www.electriciry.state.mn.us "
❑ NEW EMODEL 0 ADDITION 0 REPAIR Describe -using the ack of the�nite copy if necessary - the work covered by this request:
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401
CIRCUITS OF LESS THAN 50 VOLTS
ADDITIONS TO THE
Fee @ ;
JD101O
Ti
ONE & TWO FAMILY DWELLINGS, EACH UNIT
tncludes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspecfion Trips Each Dwelling Unit @$80
Fee
(minimum total fee is $20��� �
iH15 AREA FIXt INSPECTOR VSE ONLY
I hereby cer6fy that I inspecfed the electrical installa6on described on the d stated:
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Request Date: �9hy� �nspection {2�yuired? ❑ Yes Inspedion Other Than RougMn: �Ready VWI Call
�� o' v� You must cali the inspectar when ready! Date Ready:
I certiy that I am the �LICENSED CONTRACTOR ❑ COIu�ANY ❑ OWNER � and he�eby request inspeclion of Ihe electrical waic at;
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