P - 78607�1-�99-905 �
�t.��SS
❑ NEW - �REMODEI 0 ADDITION ❑
0 to 400 Ar
401 to 600
CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Unils
Each Additio
Fbur
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity -
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651) 642-OS00 TfY/MRS 1-800-627-3529 www•electricity.state.mn.us
� Describe -using the back of the white copy 'rf necessary - the work covered by this request:
�Sl����--7�5
Outdoor Li�hting Standard � $1 ,
III) (I�II II (II IIIII I�III II� I�� �� �� I�
L3999057
ONE 8 TWO FAMILY DWELUNGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, NI
Cirouits and Two Inspection Trips Exh Dwelling Unit �$80
TOTAL FEE I �'z; ,�{L
(minimum total fee �s $20) o'v`�
Tbs u� Fat rsaECra+ usE aar
� hereby cer6(y that I i�pec0ed Ihe elec6ical i�faNmon desaibed hdein on Me da0es st�ed:
FL>�i CiF�dCE LiSE. ii�ii"Y
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Request �e: Rough�n Inspedion RequireCt ❑ Yes Inspedion Other Than RagMn: ❑Ready NaYV WGI Caq
�/`��3 You must caN the inspectar when reedy! Dafe Reedy:
I cerlify lhat I am the �ICENSED CONTRACTOR ❑ COI�ANY ❑ ONMER and he�eby requestinspection a(1he elec6ica� wak at;