P - 78944[ /� REQUEST FOR ELECTRICAL INSPECTION
�►_ V��F - 3 6 6❑8 Minnesota Board of ElecUiciry -
1821 University Avenue Suit -128, Saint Paul, Minnesota 55104
_ � (651) 642-0800 TTY/M -627-3529 www.electricity.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION REPAIR De$s�ibe -using the b white copy if necessary - the work covered by this request: �
401 to 800
AIARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units
Each Addi6o
IIIII fIIII IIIII I(I�! I!I(I Ilifl IIIII {I{II �� I�
16743668
11187RUCTONB ON BAGK
Standard
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
( TOTAL FE j I��. �O
minimum total fee is $20
THISAREAFORNbPECTORUSE Y
I hereby certify that I inspected the electrical insfada6on described herein on the da4es sfated:
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CONTRACTOR ❑COAA�PANY ❑ OWNER and hereby
BOARD OF EIECTRICRY CAPY
lC �% — J �!
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of tlie electrical work at:
EB-0OOO7M74 8.1. ZOQ2