P - 79480REQUEST FOR ELECTRICAL INSPECTION
y. � 7 O 6 9 0 Mmnesota Board of Electncdy
o � 1821 University Avenue Smte 5428, Saint Paul, Minnesota 55104
_ (651) 642-0800 TTV/MRS 1-800-627-352� ��
xMw.elecdrictty.state.mn.us
❑ADDITION ❑
_ /%7—
Includes the Service anda Power Supply up to 500 Amperes, NI
CimiNS and Twn Incnrr.�ion Tnos EaCh DWellina Untl �$&
Nhl- fLiY-es..
FON OFFlCE U5E ONLY
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total fee is
ii- 6- �3
�'68�� �o�sa
I�� ��V` � r I Vou must call the ir�pector w�en ready! + I Date Reatly: �
I certify tha[ I am ihe�Q.ICENSEO CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspeclion ot ihe elecirical work at:
Job Atldless (Street, Box, ar RoNe No.) Ciry Zip Code
I OccupanC
� Mailing Atltlress
EB-0OD01A-03 ]Al�]W
Phone
Insislla6on)
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BORPO Oi ELEGTHICrtY fAPY INSTFUCTONS ON 6RCK OF VELLOW COM