P - 80560� REQUEST FOR ELECTRICAL INSPECTION
Minnesola Board of Eleciricity
�-�$�-3�� � 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104 _
(651) 642-0600 n'//MRS 1-800-62A3529
www. elechicify.state.mn.us
ONE & TWO FAMILV OWELLINGS, EACH UNIT
InGUdes the Service a�W(w Pqver SupplY �p l0 590 Ampe�es. All
Circuits and Two Inspeclion Tnps Each �wellinq UnA � SB�
OF
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' 1 3 8 0 3 4 1 6�
fee is
2903�
FOH OFFICE USE ONLY
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I certity that I am the f� LICENSED CONTRAC70R ❑ COMPANV ❑ OWNER and hereby request inspection ot Ne elecUical work aC