P - 78563REQUEST FOR ELECTRICAL INSPECTION
�- 412 -� 41 � Minnesota Board of Electricity � �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104� �'
(651) 642-0800 Tl'Y/MRS 1-800-627-3529 ww++�.electriciry.state.mn.us
❑ nIFW EMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy'rf necessary - the wwk covered by this request:
to 4C
)7 to
CIRCUITS OF LESS THAN 50 VOLTS
Includes the Service �dlor Power Supply up to 500 Amperes, All
Grcuits and Two Inspection Trips Each Dwelling Unil @ S�
rAMILT UriCUUVVa ru -
(minimum total �s �
tp 72 UnifS �$50 PP.� Uflif �,�,F� anusEUar
aCh Additional Unit �$25 1 h�epy �efiy y� I inspecoed tlie dxtrical instaYaOo� des�"bed �e'n on the dabs s�led:
r� ��--�3 - 2 �"�3
111\�71l1LLf1��v�� n.r�. .�� �'��-"-- -__ _ -
______.__.__.�_
___..-_.--.�..__-_.____._ .
�'�� 4��#�� ��� ����
IIIIIIIIIIIIIIIIIIIIIIIIIIIIII11111����ll�.
14128417
I cefify that I am tlie
�c��
,�.�0
Rough-in Inspedion Required? � ❑ No Inspedian Other TFian Rou9Mn: OReady Now� CaR
You must cafl the i�pec[or rea �te ReedY
�NSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request nspectio� of 1he e�l work at: