P - 75631REQUEST FOR ELECTRICAL INSPECTION �
��0 3,�� ���� � Minnesota Board of Electsicity I
= 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
• (651) 642�0800 TTY/MRS 1-800-627-3529 www.edectricity.state.mn.us
Descri� -usi the back of the avhite copy'rf nec�sa e work covered b W ueyt:
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IPOWER
CIRCUITS OF LESS THAN 50 VOLTS
�
MAY
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IIII��I
20346615
ONE & TWO FAMILY DWELLINGS, ' UNIT
Includes the Service and/or Power Supply p to peres, M
CircuRs and Two Insp�tion Trips :E ch If g Unit @$60
Addi�anal Ir�s 'on Tri $20
Imestigative Fee
Rei� 'on Fee @ $20
TOTALFEE
(minimum total fee is $20) �� �
nus ar�a cav rt�r�cron usE a�ar
I hereby ceNiy fhat I Nspeded the electrical i�alladon des�d f�ereb on dates stafed:
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IF NOT COMRLETED iTMIN 7L MUIV 11'15
F�}R tC " SE ORlLY
[�� JUN 2►5 200� $�3
�s��`7 �0/lfc�
� ^ Rough-in Inspecllon Required? (�Yes ❑ No Inspecdon Other Than Rough-In: 0 Ready Now �Qyfd Call
�� v °� "� / You must call the Inspedor when readyl �ete Ready.
I cerbfv that I am the ❑ UCENSED CONTRACTOR ❑ COMPANY 0 OWNER and hereby request ins�Ction of the eler.tric�l work at