P - 80554REQUEST FOR ELECTRICAL INSPECTION
� Minnesota Board of Electriciry
1-380-335 � 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104 �
(651) 642-0800 TTY/MRS 1-800-627$529
I www.electncity.statemn.us
Itlentiry p�a vrork covered �y ihis reques[
O%FIEW ❑ REMODEL ❑ AD�ITION 7 REPAIR XCEI ENERGY SAVER�S SWITCH
over
�U am re �& 5S ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
200 Am ere �$10 InCludes lhe SernCe antl/or Power Suppty up 10 500 Amperes, NI
IMMUNICATION, REMOTE CANTROL, SIGNALING Circuits ana Two Inspedion Tnps Each Owellinq Unii �$8�
CIRCUITS OF LESS THAN 50 VOLTS Additional InspeCtlon Tnos B$20
FEE
29028
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FOR OFFICE USE ONLY
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' 1 3803358* �O�S�
Reques� Da�e: Rough-in Inspec�ion Requiretl? ❑ Ves ❑ Inspec�ion O�her Than Rough-in' ea0y Now 0 Will Call
48l17101 Y vo� m�s� caii me msPeao� wna� ready! Da�e Reetly:
I cetlify that I am ihe L] LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection ot the electrical work at: