P - 80592'� REQUEST FOR ELECTRICAL INSPECTION
.� Minnesota Board of Eledncity
1-$$�-3`2/} �� „.. 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-6273529 '
www.electncity.state.mn.us
Itlentity the woM covered by U�is requesL
77OEW ❑ REMODEL ❑ AD�ITION 7 REPAIR
OF LESS THAN 50
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ttie Service aMbr Power Supply up to 500 Amperes. All
Circuits antl Two Insceclion Tnos Each Dwellinq Unit @ S8�
TOTAL FEE
totalfee is 5201
2906'7
i ne�eov cemiv ma� i���so��aa ue eiednaa msr uaeo� ae�neea narei� o� ma aa�� s��aa�.
�
FOR OFFICE USE ONLY
���III���II�� ��II�� ��I��� ����I�I���� �� I 2 9 p� �a,�a
Reques� Date: Rough-in InSpection FequiretlP ❑ Ves ❑ Inspec�ion Other Than Rough-in: eatly Now � Will Call
Vou mus� cdll ihe Inspec[or when reatly! Oate Rea�y:
I ceRify ihat I am ihe L� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecfion of ihe elecirical work aC �