P - 80436REQUEST FOR ELECTRICAL INSPECTION
12 5 J 3 4 Minnesota Board of Electriciry t°�°'�q
�� � 1821 Universiry Avenue Suite 5428, SaiN Paul, Minnesota 55104 x
(651) 642-OB00 TTYlMRS 1-800-6273529
�� S/15�^ wwtiv.electricity.state.mn,ua� '. '" ��
Includes the Servbe anNor Power SuOPIy up to 500 Amperes, All
Circutts and Two Insoection TnPS Each Dwellino Unit �$8(
I hereW certiN Na� I
fee is
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FOp OFFICE USE ONLY
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� � Vou must call �he inspector w�en reatly! Date p¢atly:
I cert ihat I am ihe ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecVical work aF.
Jap A40r�s �Street, 9ox, or Poule No.�
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Sec4on Township /ti ^ � O
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Occupant �
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Power upplier
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Mailing Atltlress (COnVeqq;f.p�ppg+yp�,{yvq@N�
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