P - 79369REQUEST FOR ELECTRICAL INSPECTION
° Q a� ���� Minnesota 8oard of ElectriciTy
�� 3 6 0� O v O 1821 Universiry Avenue Sutte S-1 S ul, Minnesota 55104
' (651) 642-0800 TTV/MRS 1-800 27 –^ A
www alrrtriciN.stntv.tnn.us r n
❑A�DITION ❑REPAIR
ONE & TWO FAMILY DWELLINGS, taGH UNI I
Includes ihe Service and(or Power Supply up to 5W Amperes, All
Circuits and Two Insoection Trios Each Dwelling Unit B S80
VOLTS
_— ___ _ .. . .__ _.
FOp OFFICE USE ONLY
I IZI411441114111141IIi IIIII IIIIIIICII Iflll IIII IIII
total fee is
on
2� �I9a do, so
Pequ/est Oe�e: FougM1-in Inspectqn qequlretl? �J Yes �J No Inspection IMier Than qougRln: �Oy Now V WIII Gall
/{� �� �� Vou must wll Me inspecror when reaEy! Date Reetly:
I cetlity that I am the�tICENSED CANTRACTOfl ❑ COMPANY ❑ OWNER and hereby request inspection of the eiectncal work at
��
� o�waa��
C�on Rapids.
4NC,
ortning Inslellation)
E M13 i/1/20'.�i � I BOAp�
I
Y I Phone
!
i v�.ri��
Pf�one
�(�7 :S��O
INSTiitICT1ON5 ON 6RLK OF YELLOW COPY