P - 78890REQUEST FOR ELECTRICAL INSPECTION
�., � 6 6.� —12 9� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�` , SP{, � (651) 642-0800 TT`(/MRS 1-800-627-3529 www.electricirysWte.mn.us
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❑ NEW E,M�DEL 0 ADDITIO^ ❑ REPAIR Describe -using the b�of cwh\cop�y�'rf n�� - the^rk pco��� ���`' —
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CIRCUITS OF LESS THAN 50 VOLTS
Per UN
� E25
IIIII IIIII IIIII III!I IIIII (IIII IIIiI IIIII N� I�I
1 6 6 6 L 2 9 0
ONE & 1 wu rAm�u �••«u�.��� -•- � to 500 Amperes, NI
Includes the Service andlw Power Supp�y P
Circuits and Two Inspectio� T�PS Exh Dwelling Unit @ S�
-- TOTAL FEE I !'J Q jri��
Iminimum total fee is $20) ��
�......_"-_ THSMEAFORfbPECTOR1bERiY
I hereEY c�MY � I i� ����� �bed I�dn on tl�e d�s s�d:
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��e� Rough-iri� lnspection Required? ❑ Yes No Inspection Olher Than RougMrr. �R�dy Now II Call
' .�� You must call the inspecta wh� readyl pe� R�y,
I ceAify Ihat I am Uie �CICENSED CONTRACTOR �COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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EB�00001M74 BA.2002