P - 78866� _ ^ � e' � � ^ � REQUEST FOR ELECTRICAL INSPECTION
'+ U �f �(' Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-08001TY/MRS 1-800-627-352g www,electriciry.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION EPAIR Describe -using the back of the w�e cop if necessary - the work covered by this request:
CIRCUITS OF LESS THAN 50 VOLTS
3to1
I IIII II III II II I II IO il Iil II III II �II II �II II III I I�
14168447
I ceftify that Ifam the
ONE & TWO FAMILY DWELLIN�S, EACH UNIT
Includes ihe Service andlor Power Supply up to 5pp Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
_ (minimum total fee is $20) � �� 3�'"
TMS u�n wn rcsrECron usE or.xr
I hereby certify Ihat I inspeckd the decykal in��p�p� ��y �� � y� d� �
i���
��.vmr�t i to WiTHIN 12 MONTHS
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� �o,so
Roughin Inspection Required? ❑ yps Inspectlon Other Th� R
You must call the inspeclor when ready! Date Read ��n: ��dy Now �I Call
Y
NSED CONTRACTOR ❑CQMPANY ❑ OWNER and he�eby �equest inspection of the electrical xrortc at;
EB-00001M71 8.1.2002