P - 80552REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electriciry
1=�8d-333 �° 1821 University pvenue Suite S-128, Saint Paul, Minnesota 55104
- (651) 642-0800 TTY/MRS 1-800�6273529 �
www.electricity.state.mn. us
Itlentity the woM coveretl by U�is raquest
THAN
(III II,IIIIII III IIIII��II II
' 1 3 8 0 3 3 3 3`
ONE & TWO FAMILY DWELLING$ EACH UNIT
Includes the Service anNor Power Supply up to 500
CircuAS and Two Inspection Trips Each Dwell
29Q26
i nareovi cenuv ma� i msoemea me e�ennoai ms�auauon aes�
FOR OFFICE USE ONLV
�189d. �� �'
AIl
$BO
fee is
23���
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I nw�°s! �a�e. Rough-m inspection Required? ❑Ves ❑Fla I Inspeclion O[her Than Rough-in: eaCy Now � Will Call
08�� %��� Vou must call �he'nspec�or when dyi D t R tly'
I cerliy tha[ I am [he C� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecAOn of the electrical work at:
Jab Atltlress (SVeet, Box, or flwte No.l cn, -,._ ,._._
Range
Counry
Phane
Number
Company or Owner Petlortning Inslallation) T—
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BOAFD OF ELECTRIqTY COPV
ANU4tA
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