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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 K. �.� ❑ NEW E,M�DEL 0 ADDITIO^ ❑ REPAIR Describe -using the b�of cwh\cop�y�'rf n�� - the^rk pco��� ���`' — ! O 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: ��.� �' r� � �� �� ��� �D�'��- Ol�� ��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: rob sne naa�ss rscree�. eo:. a� n�.i cn„ � � e �a -t'. mge� � �Ip� aj Ki „�5�.� I ���,a uo�� rwmn� ) EB�00001M74 BA.2002