P - 78014REQUEST FOR ELECTRICAL INSPECTION
1� 5 6 3- 7 3 3� Minnesota Board of Electricity -
G 13 $ 182� University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
(651) 642-0800 TfY/MRS 1-800-627-3529 www.electriciry.stnte.mn.us
W❑ REMO EL O ADDITION ❑ REPAIR Desaibe -usin the back f the white copy 'rf necessary - the work covered by Mis request:
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GENERAL
SUPPLIES
ALARM, COMMUNICATION, REMOTE CONTROt
GRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus � 5.50
DWELLINGS (PEI
its @ E50 Per Unit
OTHER ADDITI01
� 5.25 cer Rxture
III� IIIII IIIII IIlII II III IIIII IIIII Ilhl N� I�
15637333
St�dard
ONE & TWO FAMILY DWELIINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit � S80
TOTAL FEE I
(minimum total fee is $20) � S�
TH5 ME� FOR NSPEGTOR USE OtIY
I hereby ter0'ay tliat I inspetted the e�Ctital insfaN�on described hwein on the da�s sta0ed:
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Request Date: Rough�n Inspection Required7 ❑ Ves Inspedion Other Than Rough-In: �Reedy Now I Call
a— �3 You must call the inspecta when ready! pate Reedy.
I certiry that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑�NNER and heieby request inspection of the electrical wak at: