P - 76182REQUEST FOR ELECTRICAL INSPECTION
L�� ��� 5� 5� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 551
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.s ap
Ue�cribe -using the back of the�rhite copy'rf nec�sary - the vrork covered by this request: �l�� Zt> %� /` eC's
� CIRCUITS, CIRCURS OF LESS THAN 50 VOLTS
Each Sysbem Device or Apparatus @$.50
ADDITIONS TO THE GENERAL I
Boom
Outdoor
Standard
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F�'� ��,
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ONE & 1W0 FAMILY DWELLINGS, EACH UNff
Includes the Service andlor Power Supply up to 500 Amperes, M
Circuit4 and Two InsWectlon Trips Each Dvwelling Unit @$80
total fee is
I hereby cerd(y that I inspected the alectrical hretellaUon d�cnbed herein on Nre dat� s�ted:
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�OR OF=€CE USE CNLY
I�I � UI II111 ��� �I III ��II II I� 11III �� I� • �Gr /� J��
�CI735858 �r� � � �"�
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��� Rough-M I�spection Requbed? ❑ Yea �1Je Inspecflon Ofher Than Rough-In: {�Ready Now � WUI Catl
, v�� �� �� Yau must call the inspector when readyl Date Ready. —G �'% °�.�
I certify that I am the ❑ UCENSED COM'RACTOR ❑ COMPANY ❑ OWNER artd hereby request mspection of the electrical work at