P - 79384REQUEST FOR ELECTRICAL INSPECTION
1- 315 � 1 2 V `: Minnesota Board of Electriciry �: .
� 1821 Universiry Avenue Suite 5428, Saint Paul, Minnesota 55104
a (651) 642-�500 TTY/MRS 1-500-627-3529
www.electricity.state.mn.us
Identiy the wark covered by ihis request (�
❑NEW ❑REMOOEt ❑ADDITION ❑REPAIR � 1—� 'Y�1^V1-r-(+
GENERAL FEES Outdoor LiaMina Stantlartl �$1
OF LESS THAN 50
aver
Includes the Service anNor Power Supply uD �0 500 Amperes, All
total
� FON OFFICE USE ONLY �
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nougn-in mspeawn HequrtSa'/ U Yes `�Vo Inspection O�her Than Rouqh-In: n(5leady Now 0 Will Call I
Vw mustcalliheinspeclo�when reatlyl Date qeatly: T
NSEO COMP;ACiOR ❑ COMPANY ❑ OWNER and hereby requesf inspection of Ihe elecMral wark at
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Adtlress
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Melling Adtlress �Comradoq Company or Owner Performing Installation)
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Authorizetl SignaWre (Contrec�oL Company or Owner Petlortning Installation) Phone
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