P - 79252REQUEST FOR ELECTRICAL INSPECTION
� i� 1 O- 6 4 7� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0800TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
NEW ❑ REMODEL ❑ ADDITION _0 REPAIR Describe usin�lhe back of the white copy if necessary - the work covered by this request:
to
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CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Transformers up to 1(
Transformers over 10
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppiy up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
(minimum total fee is $20) � 20.60
THIS AREA FIXt INSPECTpt USE IXlY
I hereby cerGfy that I inspecletl the ekctrical installa6on described herein on tlie daAes sfa�d:
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Request Date: Rough-in Inspection Requireii? L] Yes LJ'No I Inspedion Oth� Than Rough-In: LJReady Now CJ WIH Call
�7��� You must call the inspecta when ready! � Date Ready:
I certify Ihat I am the �ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby reQuest inspection of the electrical work at:
IN97RUCTONB ON BACK OF YEILOIA/ COPY BOARD OF ELECTRICT' CAPY E&00001M74 8.1. 2002