P - 79368REQUEST FOR ELECTRICAL INSPECTION
,� Minnesota 6oard of Electricity
� r� 8 g. 7 4 g 1821 Universdy Avenue Suite 5-128, Saint Paul, Minnesota 55104
� (651) 642-OB00 TTY/MFS 1-800-627-3529
www. e lec trici ry. sta te. mn. us
� pNEW ❑flEMOUEL ❑ADDITION ❑
CIRCUITS
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ONE & TVJO FAMILY DWELLMGS, EACH UNI I
Inclutles ihe Service anNor Power Supply up to 500 Amperes, All
r.�m���k aM Twn Inscection Trios Each Dwellinq Unit �$8(
total fee is
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FOR OFFICE USE ONLY
I ceRity that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecfion of Me elecMcal xwrk at:
Jab Atltlreu ($�reet, Bo;, or fiou[e Np.) �,\ _, Ciry � �; � � Zip Code_ �_�
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