P - 788061-47'3-199 �6
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❑ REMODEL ❑
UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
12 Units @ $50 Per Unit
i Additional Unit @ $25
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 University u Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OB �RS 1-800-627-3529 www.electriciry.state.mn.us
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R nPSr.ribe -uci k of the white copy if necessary - the work covered by this request.
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14731996
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply �p to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$�
(minimum total fee is $20) � �/p /'J V
rws u�n Fon rsrECra+usE
I hereby cerEty that I inspecOed the elec6ical ir�allamon dexribed hwein on the dates sl�ed:
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R�:�� � Rough-in Inspedion Required? LJ Yes U No IrupeGion Other Than Rough-In: Ready Now ❑ Will Call
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�� You must call the inspecla when ready! Date Ready.
I certify ihat I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Add (St BoX ar Route No.) • Zip Code
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Sedion Township ge Fire No. County
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E&00001A•14 8.1.2002