P - 79238REQUEST FOR ELECTRICAL INSPECTION
���� O- 5 6 9� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TfY/MRS 1-800-627-3529 www.electricity.state.mn.us
NEW ❑ REMODEL 0 ADDITION ❑ REPAIR Describe -usi� the back of the white copy if necessary - the work covered by this request:
?{�EL ENER�Y SA�fEf�`S SV�liTCH
0 to 400
CIRCUITS, CIRCUITS OF LESS THAN 50 VOITS
OTHER RDDITIONAL FEES
� 1f� � i� il �i II �II II 1{I ii iii Ii 11111 III ii Iil I IIII
1 7 6 S 5 6 9 y
Outdoor Liqhtino Siandard
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTAL FEE �
(minimum total fee is $20) 20.50
iHIS AREA Fd21N5PECi0R USE O.`AY
1 herehy certity ihat I inspected the elechical instaNation described herein on tt�e da0es st�d:
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Request Date: Rough-in Inspection Required? � Yes Inspedion Other Than Rough-In: ❑k�ady Now ❑ Will Call
�7�Q�� You must call the inspecta when ready! Date Ready:
I ceitify that I am fhe CDCICENSED CQNTRACTOR ❑COMPANY � OWNER and hereby request inspection of fhe electrical work at:
fNSTRUCTOq8 ON BACK OF YELLOW COPY BOARD OF ELECTRICRY COPY EB-0OOO1M7V tl.i. zwe