P - 79286REQUEST FOR ELECTRICAL INSPECTION
,� '� ���-- 5 3 4 � Minnesota Board of Electricity
1 g21 University Avenue Suite S-128, Saint Paul, Minnesota 55104
, (651) 642-0800 TN�MRS 1-800-627-3529 www.electricity.state.mn.us
NEW ❑ REMODEI. ❑ A��iTXCEL EPlERG f Sc�AVER�'`',�- �c�iIT�F{ ite copy if necessary - the work covered by this request:
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Tvro Inspec6on Trips Each Daelling Un+t �$80
I CIRCUITS CIRCUITS OF LESS THAN 50 VOLTS
fIFAMILY DWELLINGS PER UNIT (minimUm tOtal fee iS $20) $��.50
3 to 12 Units @$50 Per Unil rwsna�nFOnir+s�cr«+usEaar
E2Ch Additi0nal Unit @$25 I I I hereby cetUry ttiial t inspec0ed the electrical installa6on described herein on the dates stated:
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Request Date: Rough-in Inspection Required? ❑ Yes inspection Other Than Rough-In: ady Now O Will Calt
Qg(2Q%Q� You must call the inspector when ready! Date Ready: �
I certify that I am the C�ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
INSTRUCTId16 ON BACK OF VELLOW COPY BOARD OF ELECTRIGTV COPV E9�a000lw-ia u.i. [w[