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P - 75692REQUEST FOR ELECTRICAL INSPECTION � � Minnesota Board of Electricity 2 �� �.14 � 1821 University Avenue Suite 5-128, Saint Paul, Minnasota 55104 -' (651)642-08001TY/MRS1-800-627-3529www.electvicity.state.mn.res ' °� Describe -using the back of the white copy'rf nec�.sary - the owrk covered by this request: GENERAL Above 200 Am ere $10 ALARM, CAMMUNICATION, REMOTE CONTROL, SIGNALING CIRCURS, CIRCURS OF L�SS THAN 50 VOLTS Each Additlonal Un(t @ I ��f^: I uu 0 UI II W� I�� II I�I II III u II� II III �� I� ?a�r�1�4o F]'�iTF?i�l ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes the Service and/or Pawer Supply up to 500 Amperes, All Ciraiits and Twro Inspectlon Trips Each DwelGng Unit @$80 Additional Insa�tion Trfas Cc� $20 total fee is I Nspeded the electrical instellatlon desatbed herehi on the dates sfa�: �r' F�7R Ok'FICE USE OPdIY �� �uG 1 � 200� �� �` � � �� Rough-in Inspectlon RequUed7 ❑Yes � Inspealon Otlier Than Rough-In: ❑ Ready No�Cell -� D 7 You must call the Nspector when readyl Da[e Ready. I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER ami hereby tequ�t mspection of the electrical work at I/T�.+� � Please Provide Two (Z) Phone Numbers Irtc \ / \ / neesmr Frecatc�an or Licenae Nwnber �/'� ,/ . .,; — /