P - 79967REQUEST FOR ELECTRICAL WSPECTION ��
1 ��� 0�� Minnesota Board of Electrictty °'
� � 1fl21 Universiry Avenue Suite 5-126, Saint Paul, MinnesoW 55104
(651) 642-0800 TTY/MRS 1-800-6273529
" www.electricary.state.mn.us �'
ADDITION ❑REPAIR
THAN 50 VOLTS
CcA-6/�c[.�
ONE 8 TW� FAMILY �WELLINGS, tPGF1 UNI I
Inclurks the Service anNor Power Supply up ro 500 Ampe2s, All
Cimuas and Two Insoection Tnos Each Dwellinp UnA �$ed
FOq OFFIGE USE ONLY
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total fee
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`� � .�p—" � Vou muet call IDe inspecto� wM1en reaay! Date Ready:
I ceN(y ihat I am ihe� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and herehy request inspecGon uf the elecVical wodc at:
Job Adtlress (Stree�, Boz, ar qoule No.) Ciry 2ip Cotle
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Section TaxnshiR Ra`ge Fire No. Couny
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