P - 80595, � REDUEST FOR ELECTRICAL INSPECTION _
Minnesota Board of Eleciriciry
1-380-327 � 1621 Universiry Avenue Suite 5428, Saint Paul, Minnesota 55104
(657)642-0800 TTY/MRS 1�800�627-3529
www. electricity.state.mn.us
IOentiry the work covered by U�is reques[
ONE 8 TWO FAMILY �WELLINGS. EACH UNIT
Includes ihe Service anNOr Power SupDN up to 500 Amperes,
Gircuits antl Two Inspection Trips Eaah DweIIInA Uni[ �
total fee is
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me
rirva���nsvec*iav � � *e
�0 �—`23'
FOR OFFICE USE ONLY
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I I HeqpESf D2�8: I Rough-in Inspection ReQUiretl? ❑Yes ❑ Inspedion O�her Than Rough-irt eaRy Now � Will Call
(�Q/77MS You must call Ihe inspector when reatly! Oate Ready
I cedily ihat I am the L9i LICENS'iD CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection oi the electrical work ar