P - 80622REQUEST FOR ELECTRICAL INSPECTION �,�.
�14 6 101 Minnesota Board ot Electriciry
1�� � 1827 Universiry Avenue Suite Sd28, Saint Paul, Minnesota 55104
(651) 642-0800 TTV/MRS i-800-627-3529 ��l ��
w�wW.eleciriciN.sta1[.»tn.us `�
IOenOry tAe wofk cover� �y iM1ls f¢quesC
❑NEW �EMO�EL ❑ADDITION ❑REPAIR ,�� �Ja�[�C�� �,p ��� ����� / p 0
50 VOLTS
ONE 8 TWO FAMILY DWELLINGS, EACH UNR
Includes ihe Service ardlor Power Suppy up to 500 Amperes, All
Cirails and Two Insoection Tnos Each Dwellino UnB �$B(
iinimum total tee is
2�t�y�y
pecial Inspectbn �$.31 per Mile � ��—' �z— �G C � I
fHIS INSTALLATION MAY BE_ORDEflED DISCONNECTED IF NOT COMPLETED WITHiN 18 MONTHS
�— — — � FOB OFFICE USE ONIV � � � —
il{II{NIIII{i� IIIII�II�iliM�l�ill����l�l +� is
�.��a 290�%,�
I i nnques va�e:�� � I nougn-in inspecnon rce0mreo � �J res p(NO I Inspeclqn Olher Than flough-In: ❑ Ready Now RWill Call I
L/9 � /� T
V You musl call ihe inspector when reatlyl Date Ready:
I cerey ihat I am ihe �LICENSED CON�RACTOR ❑ COMPANV ❑ OWNER and hereby reques[ inspection ot the elecirical xrork ai:
Job A ress (Street, Box, or RoNe No.) City Zip Cotle
_�e3�1 YY'acC���n St !�(p fv'id�-Q,� Ss'�3a-
IN�.
EB-WOpiq-13
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