P - 79471� REQUEST FOR ELECTRICAL INSPECTION �-
1 213 130 Minnesota Board of Eleanciry
� � 7821 UniversiTy Avenue SuRe 5128, Saint Paul, MinnesoW 55104
� ��- (651) 642-0800 TTY/MRS 1-800-6273529
www.electricih•.state.mn.us � �
I DNEW ❑REMODEL ❑ADOITION ❑
ONE & TWO FAMILY DWELLINGS, EAGH UNIT
InGudes ihe Sernce antllor Power Supply up to 500 Amperes, All
Circuits antl Two Inscection Tnos Each G.vellino Unit �$8(
IIIIIi111N11111111l1111111111111111IIIINIIII IIII � O�CE USE ONLY
3f 1 2 1 3 1 3 D 6 3E
I certliy tha� I am
Nat I
Vou must call ihe inspepor when ready! I O t
NSED CONTRACTOR ❑ COMPANY ❑ OWNER
RIC, �1NC.
- <x-6r 1
18 MONTHS
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and hereby request inspection M the electrical work at:
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