P - 79235REQUEST FOR ELECTRICAL INSPECTION
��` f V O- 5 6 6� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651 } 642-0800 TTY/MRS 1-800-627-3529 www.electrlcity.state.mn.us
NEW ❑ REMODEL ❑ ADDIT�r�E� E�P�Ig �Qescnbg -�u,�jng�h� b�ck�of,�g'w_hlde copy if necessary - the work covered by this request:
R Y �VCK � I C:
0 to 200
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Additional Unit @
��� �� II� I�ili �I�I �IIII I���I �II� II��� �I�I
1�76$5660
Outdoor Liohtinq Standard
ONE 8 TWO FAMILY DWELLINGS, EACH UNIi
Includes the Service and/a Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Reins tion Fee $20
TOTALFEE
(minimum total fee is $20) 20.50
TMiS MEA FOR INSPECTq2115E OKY
I hereby cerlify Mat I inSpected ihe elettncal installation describeU herein on the dates sta0ed:
-(Y �Y
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0�00�� - C�l ��ir��� �6 �
Request Date: Rough-in Inspection Required? ❑ Yes �'No Inspedion Other Than Rough-In: Okdady Now � V1rt11 Cail
07��� Yai must call the inspector wh�en ready! Date Ready.
I certify that I am the D�ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electrical work at::