P - 78835.
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�O NEW ❑ REMODEL ❑ ADDITION �(
�/� ,.... .. �-1 _ �... � '2 � C'S
0 to 400
COMMUNICATION, REMOI t GUN I rcu�
S. CIRCUITS OF LESS THAN 50 VOLTS
12 Units @ $50
i Additional Unit
Center
REQUEST FOR ELECTRICAL INSPECT�ON
Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.ele ricity.state.mn.us
IR Describe -using the back of the white copy if necessary rk covered by this request:
— 1� ,�a�� Ylt�t@fd_ F'' �
� Special Inspection $.31 per Mile _
'HIS INSTALLATION MAY BE ORDERE
� �NIIII�IfIIIIINIIillll�
li��lllllllil� IIIII
�,7526732
10
ONE 8 TWO FAMILY DWtLLINGS, tnGn um i
Includes ihe Service andlor Power Supply up io 500 Amperes, All
Circuits and Two Inspection Trips Each Dweiling Unit � E80
Fee
TOTALfEE �
(minimum total fee is $20) p�d -�
TNIS MEA FOR N6PECTIX2 USE ONv
I hereby cer6(y that I inspec0ed the electrical installa6on described herein on tlie daBes staAed:
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Request Date: Roughin Inspection Required? O Yes Inspection Other Than Rough-In: Ready Now ❑ Will Call
GYou must call the inspectw when ready! Date Ready:
I certiTy tliat I am the �6tCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby req�st inspection of the etechical work at:
INSTRUCTONS ON BACK OF YELLOW COPY BOARD OF ELECTRIGTV COPV EB-0OOOtA-U 8.7. 2002
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