P - 79625REQUEST FOR ELECTRICAL INSPECTION
I _ � � � - � � � . Minnesota Board of Electricity
1 1821 Univereiry Avenue Suite 5-128, Saint Paul, Minnesota 55104
- �r.-*k� (651) 642-0800 TTYlMRS 1-800-627-3529 //j �
www.electricitV.stute.mn.us y/G'Y`
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IdeMiry the wark covered hy this request: �0��� �✓/S //�/�
❑NEW �REMOOEL ❑AD�ITION �pREPAIfl /' T �! /����/�E� �
Includes tAe Semce anNOr Power Supply up to 500 Amperes, All
Circuits and Two Inscection Trios Each Dwellinq Unit �$8(
FON OFFICE USE ONLY
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I cerlity that I am the
Job Atltlress (Slreet Box.
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total fee is
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LETED WITHIN 18 MONTHS
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� Vou must call ihe inspector when ready! I Date Readp � � I
LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and herehy request inspedion of �he eledrical work at:
or
Range
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INSTPUCTpNS ON BACK OF YELLOW LOPY