P - 79706REQUEST FOR ELECTRICAL INSPECTION
` Minnesota Board of Electriciry
1� 18 9- 6 5 9� 1821 Universiry Avenue Suite 5-128, Saint Paul, Minnesota 55104
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www.e[ectricity.state.mn.us .
Identiy [he wark covered by ihis request: �
❑NEW ❑REMODEL ❑A�DITION ❑REPAIRYClYIIIP�YIn/Ff IA11/IO-F/!1'�.N iAYI/I��v •
OF LESS THAN
� S20
Inclutles the Service arMlor Power Supply up to 500 Amperes, All
CircuAS antl Txro Insoeclion Tnos Each Dwelling Unit �$8C
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FOR OFFICE USE ONLY
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I cetlity Mat I am ihe �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNEfl and herehy request inspedia� of the eledrkal work at:
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BW1ND OF ELECIHICRV COPY
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INSTHUCTIONS ON BRCK OF YELLOW COPY