P - 80470� REQUEST FOR ELECTRICAL INSPECTION
'• � � Minnesota Board of Electncity
�� 14 6� O�� 1821 University Avenue Suite 5-728, Saint Pflul, Minnesota 55104
// /'� �.pm�. (651) 642-0800 TTV/MRS 1-800-6273529
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NEW IqREMODEL ❑ADDITION ❑REPAIR (�')KJ �V���� ��J� �J��-7 / 7�"
Includes ihe Service anNOr Power Supply up to 500 Amperes. All
Circuits and Two Insoection Trips Each Dwelling Unit �$B[
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" FOR OFFICE USE ONLY `
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L rj ��`� -� U� I You must call t�e inspector when reatlyl � Da[e Featly: � �
I cerlify ihat I am the �LICENSED CONTRACTOR ❑ COMPANV ❑ OWNER and hereby request inspecfion of ihe electncal work at:
.bb Atldress (S[ree6 Box, or Route NoJ Ciry Zip Code
10yo r�ar..��-,�����, �',. �ic�(��., c�-9.�.�
� Mailing
E6000�1F-13
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OF ELECTFICRY GOPY INSTHOLl10N5 0N BRCK OF VELLOW COPV