P - 79454REQUEST FOR ELECTRICAL INSPECTION ���
�� 2�13 - 4 51 Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-B00-627-3529
` www.electncirystate.mn.us ��/�93
Identily ihe work coveretl 6y this request /
❑NEW ❑REMODEL ❑ADDRION �REPAIR � "'� ye �"'�'�
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Inclutles ihe Service anNor Power Supply up to 500 Amperes, All
Cimuits and Two Insoection Trios Each Owellino Uni� �$BI
or
FOp OFFCE USE ONLV
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Va� �� � l I Vou must dll ibe inspec[or when rsatly! I �ete Reatly: I
I cetliTy ihat I am ihe �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecibn of ihe eledrical work at:
Job AdtlrBSS (SVeeq Box, or Route NoJ � Ciry Zip Code
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iny or Ownar PeROrming Installa�ion)
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BORP� OF ELFCTHICITY
Phone
743-5�/- �9�/
3 �-
Phane
743— $7!- "7�47
WSTIIULTIbNS ON BACK OF YI
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