P - 78900REQUEST FOR ELECTRICAL INSPECTION � � �
1� 6 6 6- 4 6 2� Minnesota Board of Electricity ,- �,
1821 University Aven -128, Saint Paul, Minnesota 55104
, (651) 642-0800 TTY 0�27-3529 www.electricity.state.mn.us
❑ NEW ❑ RE EL p DITION ❑ REPAIR Des�ribe -using the �c ihe white copy'rf necessary - the work covered by this request:
� .. _ _
UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus � Ssn
Per Unit
Each
Hour
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Txro Inspection Trips Each Dwelling Unit @$80
(minimum total fee is $20) � ,�jl,'(J ��J
TIYS ME� Fqt MLSPECiOR USE ONY
I hereby cer5ry that I inspec0ed the electrical inshalWAon described herein on Ihe da6es staAed:
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GOMPLETED WITHIN 12
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CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request mspection of the electrical work at:
o�.�.0 �+r c�e� i nica � r covr
EB-00001M14 8.1.2002