P - 799421-153-767
� �NEW ❑PEMODEL ❑ADDITION
BE
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 University Avenue Suite 5428, Saint Paul, Minnesota35104
(651) 642-0800 TTY/MRS 7-800-627-3529
www.elecariciry.s[ate.mn.us
G`t44(¢2 SE'!t(1/C'e ( O KclGf'�Cl+lia«R�
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ONE & TWO FAMILY DWELLING$ EACH UNIT
Includes the Service anNOr Power Supqy up to 500 Amperes, All
Circuits arid Two Insoectlon Trms Each Owellino Unit �$Bf
FON OFFICE USE ONLV
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FeQueat Uate: Faughin Inspeclion qequiretl? ❑ Ves o
herein on ihe dales staNtl:
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I certify [ha[ I am the �ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspedion of the eleclrical work at:
Aob Adtlress (Street, eox, o� Rou1e No.) Ciry �_ 2ip Cotle
Fire
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or Owner Pertortning Installetbn) ' P na
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ELECTPoplY COPY INSTNUCTIOHS ON BACK OF YELLdN LOPY