P - 793821-332-282 ��:
Identiy Ihe wark coveretl by this request
❑NEW ❑REMO�EI ❑ADDITION
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REQUEST FOR ELECTRICAL INSPECTION
MinnesoW Board of ElectriciTy ° `
t921 Universiry Avenue Suite 5728, Saint Pau1, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-6273529 �-�
www.electricity.s[ate.mn.us
/�i � /t�.y� /?r oGiG
INJE & TY✓O FAMILY DWELLlNGS. EACH UMT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Insoecfion Tri�s Eac� Dwellino Unit �$e[
Special Inspectbn � $.31 per Mile � � ` � �� �O�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED 1 T COMPLETED WITHIN 18 MONTHS �
llllllllllllllill fll Ilil III IIII I I I I��E�E�Y ��3 �� r� �`�
�c 1 3 3 2 2 B 2 I) I(I� � �
Requesf D (toagl�-m Inspecfbn Required? ❑ Yes o Inspectlon Other ihan ough-In' fteaGy Now � Will CaA
�/ Q` Vou must call [M1e inspector when reatly! Date Ready: /I
I certify that I am the LICENSED CONTRACTOR ❑ COMPANV ❑ OWNER and here6y reques[ inspection ot the elecirical work at:
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or
Fire No.
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Phone
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� ORHD OF ELECTPIQTY COPY RISTqUCTpNS ON BRCK OF YELI