P - 79379REQUEST FOR ELECTRICAL INSPECTION ���
�3 0 3 8 4 g Minnesota Board of Electricity
� � 1021 Univereiry Avenue Suite 5-128, Saint Paul, Minnasota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529 .�
. www.edectriciry.state.mn.us G !
t
Itlentity ihe work coveretl by thi5 reQuest
� ❑NEW ❑REMODEL ❑ADDffION ❑REPAIR IV1��71 P� �VVIG�O�O'IC �T/1�/C �/.LTVl-t�11
THAN 50 VOL
Includes Ihe Sernce anNor Power Supply up to 500 Amperes, All
i5
S arate Bo�in Ire ion �$2�
5 cisl Ins eclian �$30 er Hour xs�r�u,
S cial Ins ection � 5.31 per Mile �� —
THIS INSTALLA710N MAY BE ORDERED DISCONNECTED IF OT COMPLETED WITHIN 18 MO T S
— �,��E�SE��� _ aci a. a `v��-
I111111118111fIIINlllllllllNIIINIIIIIIIIIIII �x���3 �y�
3� 1 3 0 3 8 4 9 2* �
I u�� `(] - V 0' � Vou must WI the inspector when reatly! � � Da�e Featly i •'"� � �
I ce�tily that I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER antl hereby request inspection ot ihe eleclrical wrork at:
�, Job Adtlress (Slreet, eo:t, or Route No.) Ctty Zip Cotle
��_, ,.,._ �, ...� n � ,� _ �._.
1
E0L0001A-13
Pho�
- � �I� �71-�7
� ��� �
IXi BACK OF YELLOW COPV