P - 79268REQUEST FOR ELECTRICAL INSPECTION
1 3�5 4 714 q Minnesota Board of Electricity
� � 1821 Unrversity Avenue Suite S-128, SaiM Paul, Minnesota 55704
; ta�=a (6,51) 642 0800 TTY/MRS 1-800-6273529 '�;,,,�
www.efeciricity.smte.mn.us �, �_ ' '
ItlenGtyi�e wark covered bythls aquest: ,_ ( �
❑ NEW A REMODEL ❑ADDITION ❑ REPAIR vv r r�� v� .
Includes the Sernce andlor Pmver Supply up to 500 Amperes, All
SIGNALING Cirwits and Two Inspecfion Tiips Each DrueVNng Umt �$et
total fee is
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I cetlify Nat I am the �`LICENSED CONTRACTOR ❑ COMPANV ❑ OWNER antl hereby request inspeclion of ihe elecVical work at:
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