P - 793611-348-232
work caveretl OytNS request:
❑FEMODEL ❑ADDIiION ❑REPAIR
CIRCUIiS OF LESS THAN 50 VOL75
REQUEST FOR ELECTRICAL INSPECTION �,g��
Minnesota Board of Electricity
1ffi1 Universiry Avenue Suite 5-128, Sainl Paul, Minnesota 55704
�ssi� sa2-osoo rrvmnas i-aoo-sz�-as2s �
www.elCCb'tL4ty.slate,mR,us .
Mclutles ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inweclion TriPS Each Owellinq Unit � 58C
INIIIIIIIlIIN11111111111181111llIIIiIIfIIIIINI O�FICE USE ONLY
V G� Ypu must call Me inspBCror when reatly!
I ceeiy fhat I am the LICENSED CONTRACTOR oare
Jo6 Atltlress (SVeey Bpx, or Routg No.) � COMPANY ❑ OWNER
l�,ll�n;�i: �`,._'nf_.. _ °:r , ..
v.r c .? Ph�,e
Atltlress y�'
�
i L; �,
IICon/h�a or Lica�e w
or Owner Pertprming Installafiont-1) �
S�- !1 A,r.� A��,
� y or O�.mer partormmg Ins�allatlon)
�`
BWqO OF ELECTRICRy �pry
�_iCJ_o�
��3<<
�Ss�
and hereby req�esf inspecfion of the elecMCyl work at: �
�
!