P - 79605REQUEST FOR ELECTRICAL WSPECTION ,.�
1-13 9� 1 1� Minnesota Board of Electricity
1827 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
�2 r (651) 642-0800 TTY/MRS 1-800-627-3529 ���
J I www.electncity.state.nm.us
lemiry t�e wark covered hy ihis aquesf: C�. �/1
J3'�EW ❑HEMODEL ❑ADDITION ❑REPAIR�" ���u�� ��
ONE & TWO FAMILY DWEWNGS, EACH UNIT
Includes ihe Service anNOr Power Suppty up to 500 Amperes, All
Circuits aiM Two Inscec�ion Trios Each Puelliiw Unii �$8C
rotal fee is
I herebv ceNiv Ihet I�nspectee Ihe
�
FOp OFFlCE USE ONLY
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIINIIIIIIIIIIIlI .��9�s �s.s�
� j L� 1.0 ��..y�ir � Vou must call M¢ inspecior when rea�ty! I Da�e Rea7y: I
I certity that I arn the �ICENSED CONTRACTOA ❑ COMPANY ❑ OWNER and herehy request inspedion of the eledrical work at
Jo0 Atltlress lSYreat Boz. or Raute No 1 Cilv Tin Cmo
Number
Campeny or Oxner Pertorming