P - 79362REQUEST FOR ELECTRICAL WSPECTION
1 3 4 8 2 31 Minnesota Board of Electriciry
� � � 7827 Universiry Avenue Suite 5428, Saint Paul, Minnesofa 55104. t
e;*'9- (651) 642-0800 TTY/MRS 1-SOP627-3529 ��
www.ekctrfciav.state.mn.us
Itlenl'Ry [he work covered by ihis request:
WNEW ❑REMOOEL ❑ADOITION ❑REPAIR
Inclutles ihe Service anNor Power Suppy up to 500 Amperes, All
Circuits antl Two Insoection Tnos Each Dwellinp Unil �$8C
FOfl OFFICE USE ONLY
IIII�II111l�IIIIIIIIIIIIIIIIIIIIIJIII INIlllllflll
3E 1 3 4 B 2 9 1 O�f
Yes
total fee
t,� . /-7 !' -"3 I
ireRlletion descnped herein on �he dales slated:
��b�ll g�so
/, - � _ ._•-___. _.._. ..._...__e...... �..___,...,.. I I
� V Vou mus[ cell �he inspec[or when reatly! Date Reatly�
that i am ihe�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electncal work at
li
Iress (Stree4 Box, or Route NoJ I CAV ��� c,.no
c
vnship Range Fire No. Ci
a � .
Ph
J �
Atltlress
��
or / Camparry ( I Co 2ctor Licens
��
:ont c r� Com any o� Owner P tlorming installation) �
G� �
re( �ado�, Comperry or Owner PeAO�ming InstallaHOn)
BOMU OF ELECTPICITY COPY
�