P - 79354� REQUEST FOR ELECTRICAL WSPECTION
1� 3 21 � O� 6 Minnesota Board of Electricity
1821 Universi Avenue Suite 5-128, Saint Paul, Minnesota 55104 ��s
(651) 642-0800 m'M1RS 1-SOo-6273529
' www.electriciry.st¢te.mn.us � �
❑ REMODEL
OF
❑REPAIR
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I�ludes the Sernce azW(o� Powe< Supply up W 500 Amperes, AII
Circuifs an0 Two Inspection Trips . Each Dwelling Unit �$81
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FOR OFFICE USE ONLY
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I certMy that I am the
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NSED CONTRACTOR ❑ COMPANY ❑ OWNEfl
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and hereby request ir�spedion W the e�ecincal work at:
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INSTflUCTIONS ON BRCK OF YELLOW COPY