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P - 78574REQUEST FOR ELECTRICAL INSPECTiON 1� 4,� /I � Q O 7 � Minnesota Board of Electricity �f •J 1g21 University Avenue Suite S-128, Saint Paul, Minnesota 55104 (651) 642-0800 TTYIMRS 1-800-627-3529 www.electricity.state.mn.us EW ❑ REMODEL 0 ADDITION ❑ REPAIR Desc�ribe/-�using the back of the white copy'rf necessary - the work covered by this request: ,f"'f C/�---�� to E& WO FAMILY DWELLINGS, t/+�r+ �ni i � ihe Service andlor Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dweliing Unit @$80 CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS „,,,,� � �„�.,, � „ , , ._ .,�.._. _ ._ . --- TOTAL fEE 4 s fIFAMILY DWELLINGS PER UNI (minimum total fee is $2�) •.�7s p 3 t012 UnitS Q$50 P� U�it THisu+�nFOnrc�cr usE aar Each Additional Unit @$25 1 hereby cerOry` th'at � i�sDe�ted the �� �^��°^ ���d h�n °° tl� da�s sta�ed: nTHFR AnDITIONAL FEE$ K !S :r �C��c,�-ti-�— /� ' � `- G! THIS INSTALLATION MAY BE ORDERED DI`3c.vnn��. � c� �r �v � ....�. .-- • -- --_•_ -_ _ _ _ _ __ __ _ _ _ _ – _ _ Illil Ilill II�II IIIII IIIII II�I II� �� �� i� ��� � 14249072 � f �fI�,SQ �.� l0''°3 I certify that I am the Rough-in Inspection Required? es O No Inspedion Other Than Rough-In: LJReany rvow/�e"n' �+"' You must call the inspec[ar v+hen ready� Date ReadY :NSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of 1he electr�al wo�C at. INSTRUC" �OMB ON BACK OF YELLOW COPY BOARD OF ELECTRICITV COPY E6000D7M14 8.1.2002