P - 787311-4��1-719 �2
❑ NEW ❑ REMODEL ❑ ADDITION
CIRCUITS CIRCUITS OF LESS THAN 50 VOLTS
�er Unit
� $25
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity .-a_ ui, Minnesota 55�oa
1821 University Avenue Suite S-1 � ��' e[ectrici state.mn.us
(651) 642-0800 TTY/M . 1-80 2� • h'•
_ . ..� �__�. _.,u.....�,,.e ..,,., f�o�sarv - t work covered by this request
IIlII IIIII IIIII NIII IIIII IIIII IIIII IIII1 �� I�
143L7192
I ceRiiy that I am tlie
��l/��
ONE & TWO FAMILr uwt�un�a, v1�.� �+^� �
Ir�cludes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspec6on Trips Each Dwelling Unit @$80
(minimum total fee is $20) � �JCI�/ J�
THIS ARFA FOR IKAECTpi USE QlY
I hereby ceNfY that I inspetted Me elecbic� instaMa6on desaibed haeia on the da�s shated:
���� � _ � _ c�
a�
COMPLETED WITHIN 12 MONTHS
��i�3�
ao,so
� Rough-in Inspection Required? ❑ Yes ❑ P1c Inspedion Other Than Ra9h-In: Y
►� ❑ v�i can
� Q� You must cal� the inspector when ready! Dffie Ready: .
rl �.���.�ecn rrwrRer.TC� f-iCOMPANY ❑ OWNER and hereby �equest inspecbon of the e�ctr�� W°rk ax:
gpqRp OF ELECTRICITV COPY
Eg.00001A-14 8.1.2002