P - 77241REQUEST FOR ELECTRICAL INSPECTION
1� 610 - 5 9 4� Minnesota Board of Electriaty
1821 U�iversity Avenue Suite S-128. Sairrt Paui, Minr�sota 55104
(651) 6?-0800 TiY/MRS 1-800�27-3529 www.electricity.state.maus
❑ NEW ❑ REMODEL � ADDITION REPAIR Despibe -using the back M the white copy rf necessary - Me work covered by this request:
%! �%�/�'�' ✓ Q��.Ee../ �iT�_ /��> J�t��1�'✓C G" �� �' /fi�La: �'1%
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401 to 800
I Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Additional Unit
MAY BE ORDERED DISCf
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16106940
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Fee
Includes the Service andlor Power Supply up to 500 Amperes, All
Grcuits and Two Inspection Trips Each Dwelling Unit �$80
(minimum total fee is $20) � ,'(�i'7 "
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I hereby cer6y tl�at I inspecled ihe electrical instaY�on desaibed heiein on the da0es sF�Oed:
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Kequ�[ : Rough�n Inspection Required? LJ Yes /A`NO Inspedion Olher Than RougMnf�AlR�dv No+� LJ VWI Call
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I� �� You must call the inspedor when readyl pete Ready,
I certi(y tliat I am U�e ICENSED CONTRACTOR ❑COWIPANY ❑ ONMER and hereby �equest mspection of the electrical work at: