P - 79493REQUES7 FOR ELECTRICAL INSPECTION
1 13 9 161 Mmnesota Board of Electriciry
� � �": 1827 Unrversity Avenue Suite 5-728, SaiM Paul, Minnesota 55704
��� � *� � (651) 6420800 TfVlMRS 1�800-627-3529
www.electriciry. siare.mn.us
work covtretl by this requesf. ���� ��, n�. ���n C�G O
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❑REMOOEL ❑ADDITION ❑REPAIR
ONE & TWO hAMILY UWtLLIrvtiJ. tn�n orvi i
Includes ihe Service anNor Power Supply up to 500
Cirouits antl Two Inspection Trips Each �wellir
OF LESS
I�III�I �Ilil �II�I ��I�I I�III I���I II��IIIIII IIII IIII FOfl OFFICE VSE ONLY
x 1 1 3 9 1 6 1 c x
total fee
es, All
� $8C
atlon tlesaibetl herein an Ihe Gales s
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�/ L�L(J "' (,� I Vou musl call t�e inspec�w when reatly� I pe�¢ q�y� {
I cehiy Mat I am Ihe �LICENSE� CONTRACTOR ❑ COMPANY ❑ OWNER and here6y request inspaqion of ihe eledrical work at:
Job Atltlress (Slreeq Boz, or Route NoJ Ciro e:_ �_..
Phone
or UmerPerforming Inelaila�ion)C �`
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