P - 79403REQUEST FOR ELECTRICAL INSPECTION
�� 3 5 3- 9 2 6 Minnesota Board of Electricity
1821 Universiry Ave 'te S428, Saint Paul, Minnesota 55104 j
.�, (651) 642-0800 !��1� 1-800-6273529
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I C�NEW
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Includes ihe Service anNor Power Supply up to 500 Amperes, NI
Cir�iite and Two I�oection Trios EaCh Owellina UnH �$80
tru—/c-rC,o+—
total
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Soecial Insoecuon �$ 31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
� FOP OFFICE USE ONLY
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I/(/ �a (�� � You must call ihe inspecror when �eatly! � Oate Reatly: �
I certity ihat I am ihe�NSED CONTRACTOR ❑ COMPANY ❑ OYVNER and hereby request inspection of the elecirical work at: �
Job Adtlres (SYreet, Box, or PoNe NoJ M Z,p Code
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