P - 80013• REQUEST FOR ELECTRICAL INSPECTION
MiMesota Board of Electricity _
1_3s1 _$gg � 1821 University Avenue Suite 5-128, Saint Paul. Minnesota 55104
(651) 642-0800 TfYIMflS 1-800-627-3529
www.electricitystate.mn.us _
❑
covered hy tttis request
THAN
{ fli�l Ilal a�l �II �IN a�l N�I �a N� II
ONE 8 TWO FAMILY DWkLLINti
Inclutles the $emce antl(ui Powe�
Ciraits and Two Inspection TnDs
to SO'J Amperee, P.0
i Dwelling UnA � S00
T�TALFEE
m��mtotalfee is $20)
�����._--_ _�_� �_'
i��C�OM�P�LETED WITHIN 18 MONTNS
FOR OFFICE USE ONLV
l�y�� ��s°
oecM1On Othe� Than Raugh�i¢ eady Now � WiA Gall
� (JfJJty(�Jj � Vou Inus� call ihe inspector when reatly! � Da�e Featly: _ �
I cetlify that I am the � UCENSED CONTRACTOR ❑ COMPANY ❑ OWNEq and hereby reqoest inspec6on oi the elecirical work ffi: