P - 79665REQUEST FOR ELECTRICAL INSPECTION .�
� _ � � � ` � � ^ , Minnesota B�ard of Electncity
� �* 5821 Urnvers� Avenue SuRe 5-128. SaiM Paul, Minnesota 55104
' " �� (651) 642 0800 TTYlMRS 1-800-6273529 ��� ��
www.elecrncary.state.mn.us
�dentity the work coveretl by Ihis request: I
❑AODITION ❑REPA�fl
ONE 8 TWO FAMILY UWELLIrvIis, tH�n urvl i
Inclutles ihe Service anNOr Power Supply up to 500 Amperes. All
Circutts artl Two Insoecfion TnOS Each Owelling Unit �$8(
FOfl OFFICE USE ONLY
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tOtal fee i5
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� (J U� You must call the i�peclor w1»en �ea0y! Date Reatly:
I certify Nat I am th�{CICENSE� CONTRACTOR ❑ COMPANY ❑ OWNER and hereby requesf inspscfion of the electncal work at:
Job Atltlress �Sireeq Box, or Route No.) Ciry Zip Cotle
yi� �s�, �v� �'�,���e� �Sy�/
Section Township Hange Fire No. CounN .
� Mailing
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Coniraqo�r Lkeyns,e/ �Number Master �ice
/T/ll�/1155�
or Owrer Pedortning Installation�
� P in stallation) Phone
63- %:
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