P - 79495REQUEST FOR ELECTRICAL INSPECTION
.. 1-13 9� 1 V� �_. Minnesota Board of Electricily . 9
1821 Universiry Avenue Suite 5428, Saint Paul, Minnesota 55104
�^� I '� ' (651) 642-0800 TTV/MRS 1-800-627-3529 �
( rvww.electriciry.state.mn.us
� worx cweratl Dy tms req�est: /CQ � G�� .y /y��y{ p
❑REMOOEL ❑AD�ITION ❑REPAIR `" ' VI� R�I�I �w/ /` / `N L/�
Includes ihe Sernce andlor Power Suppty up to 500 Amperes, All
Circuits antl Two Insoection Tnos Each Dwellinq Unit � E8(
OF LESS THAN 50 VOL7S
Ihe
FON OFFlCE USE ONLV
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3t 1 1 3 9 1 6 3 B�
total fee is
� ��'9s $5,s-v
L� L. �L(f �1{��� � Vou must call pie inspactor whan reatly! I D t qeatly I
I certity that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the eledrical work ak
BOAqD OF