P - 79570REGIUEST FOR ELECTRICAL INSPECTION ��
°�Q Minnesota Board of Electriciry
1��.7.j -16 4 1827 Universtty Avenue Suue S428, Saint Paul, Minnesota 55104
. y�v�2f (651)642-0800 TTVlMRS1-800-6273529
%�" [w� www.electricity.stade.mn.us
V'
len/tify' the wark cwered by ihis request: � � 4 y� �,, ���' p
x(JEW ❑REMODEL ❑ADDRION ❑REPAIR ��V`� R•'�QUII'W� lr--/��f/J �+'1"�
ONE & TWO FAMILY �WELLINGS, EAGH UMf
tncludes ihe Service anNrn Pavei Supply up to 500 Amperes, AN
Cirr.uBS antl Txro Insoeetion Tnos Each Dwellinq UnH �$BC
50 VOLTS
FON OFFICE USE ONLY
f lfflll111I1 ilili 1181111ii lilfl iilll illll lii! Illi
� . G
]q"E
�� -L
,�.���� 3�s�'
���. Ll% LFii I I You must call ihe nspector whan reatly� � Date Reatly: J
I cer[iy Ihat I am the �CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecirical work at
Job Atltlress (Street, eox, w Route No.) Ciry Tp Cotle
or
]I1MOW
Phane
� I ��� � � I
ELECTNIqTY COPY INSTNUGTONS ON BqCK OF YELLOW COVY