P - 81338RE�UEST FOR ELECTRICAL INSPECTION ��
1 ��� ��� Minnesota Board of Electricity
� � � 1821 Universiry Avenue Suite S-12B, Saint Paul, Minnesota 55104
r. $a.'.� (651) 642-0800 TTY/MRS 1-800-627-3529
www. elecirrcity. sta[e.mn. us
IBF1EW ❑REMODEL ❑AODITION
THAN 50 VOLTS
Includes ihe Service anNOr Power Supply up to 500 Amperes, All
Cimuirs and Two Insoection Tnos Each Dwellino llni� �$80
�tit'e c.' `"" �
---------------- -- ---�---
FON OFFlCE USE ONLV
1111111111fllllllllllllllllllllllllilllillllllllll �,���
R�t�� � flough-in liupedian Requi�etl? ❑ Ves No Inspection Otli�
{ � Vou must cell Ihe inspecbr when ready! Date ReaCy:
rotal fee is
/ Z- -.
�, _�
I ceNfy that I am Ne ❑ LICENSED COMRACTOR ❑ COMPANY OWNER and hereby requesf inspection of the electnral woAc at
Jab Address (SVeet. Boz, w Route NoJ ,/�� Ciy � / Zp
� � O ��C ST 1�CV.t ✓' K-- � [/� tC.% '�- �
so,n�nn im.nsnin Ranne . Fire No. CounN .
v G` � O �c
OccuPan[ �dr\ V � ` ��S Phone � � —V
Paver Suppliet Atldress
� � L /t/� � v�
Elec�rical ontrac1or / Company Name Conirac�or License Numter Master Li�
S � ��^
Mailing Addre s(COntrac�oq Company or Owner Pedortning ns I' f
t .�-�--5°`.���C
INSTNUCtION3 ON B�CH OF YELLOW