P - 78786—r
REQUEST FOR ELECTRICAL INSPECTION
1� 4 8 2- 315 7❑ Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, ' ta 55104
' (651)642-08QOTfY/MRS1-800-627-3529 icity.state.mn.us
e work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION EP � Des�ibe -u ng he b„ of the; �te co�if nece�sary C f
� .f' y'�7
/' `_ • 1 ( (r(J'� i � i
to
3 to
CIRCUITS OF LESS THAN 50 VOLTS
;vstem Device or Apparatus @ $.50
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Fee
n� i v i n� ���vc�� � ��� TOTAL FEE _' ^' G�
3S PER UNI 0��(J �,J
Per Unit (minimum total fee is $20)
rws ��n Far� nsaEC�oa use aar
�$25 I I�reby cw6fy mal I inspected ttie elecbical insUlla6on described herein on the dates sfa�d:
uFaanniTioNALFEES NK �`�S'�
n�� u.....-.��...�."-'-" -- -
II�II IIIII II�I� III�I IIIII IIIII IIIII IIIII �� IIIII
14823157
Req Rough�n Inspeclion Required? ❑ Yes
You must call the inspecla when ready!
I certify that I am the �ENSED CONTRACT� ❑�N�A�
INBiRUCTONB ON BACK OF YELLOW COPY
G�-� 9��
`No Inspection Other 1'�i
� Date Ready. /
--t
❑ OWNER and hereby
BOpRD OF ELEClF21CITV COPY
3- z 3--a`F
�O . S�
N�, a uv�i can
of the electrical work at:
E&OOOU1M14 8.1.2002