P - 79356REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1��� j� � 0� l 1821 University Avenue Suite 5-728, Saint Paul, Minneso<2 F�5104
� v ,�_ (651) 642-0800 TTYMIRS t-800-627-3529
� xnvw.electriciry.saate.mn.us _« C,��y�.,��.�fo�,
ihe worx covereu
� ❑REMOOEL
LESS
ONE & l WV FAMiLY urvtwrvb:
Includes �he Senice anNor Power
Circuits and Two Inspec[ion Trips_
FOfl OFFICE USE ONLY
I IIIIII INI{ {iill Ill{i i{Ili IIlINI{II Ilill IIIIIIN
�f 1 3 6 O O 8 7 9 3E
e�
500 Amperes, All
total fee
,�''�''��%1.s�
/ �.u�yn-n� inspzaion neqmreor I J Yes �J No I Inspectlon OMar Than Rouqh-In: ❑ Reetly No all
I��(Q �� Vou must call tlie inspecto� when reatly! 0 � R etly
I certity tM1at I am 1heC�,I.ICENSEO GONTPACTOR ❑ COMPANY ❑ OWNER and hereby request inspecfion of ihe elecMcal work at:
Job Adtlrgss (SVeet, Box, or Ro e No.) Ci
�T<7I � �% �� /) if' -7- i . %%. Z'°�°°-�./S�/
� oco�aan�
E&OppO1R-13 ]H2000
Phone
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