P - 78876REQUEST FOR ELECTRICAL INSPECTION
1� 6"� 9- 2 2 7 2 Minnesota Board of Electricity
�` 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-08Q0 TlY/MRS 1-800-627-352g www.electricity.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION REPAIR Describe -using the back of the white copy if necessary - the work cpvered by this request:
w.°�ee F�Rn�ce
CIRCUITS OF LESS THAN 50 VOLTS
Unit
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service �d/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit � a80
_ (minimum total fee is $2p) � e,1 p so
� �1EfCb iM5 A1tEA Fp21N5PECTON U5E QlY
Y ceN�Y ihat 1 ins�d the electritai insfallafion described herein on the d�s sfakd:
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�2 SPeaion RequiredT ❑ Yes P�p Inspedp� py�� Than RcwgMn: Ready NW�y � y�l Call
v �� �� y You must call the inspectpr when �dy�
Date Re�y.
J certify ihat I am ihe �I LICENSED CONTRACTOR ❑COAAPANY ❑ OWNER and hereby req�st inspec�� ���� �� ati.
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