P - 79974REQUEST FOR ELECTRICAL INSPECTION ,y;��
1�118g 0 g Minnesota Board of Electricity
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OB00 1T1'1MR5 1-800-6273529 �!
� www.electricdty.statemn.us "�
� ALARM,
REMODEL ❑ADDITION ❑REPAIR
�IOTE CAt3TR04., SiGNALING
THAN 50 VOLT$
✓LO `
ONE 8 TNO FAMILV OWELLIN(iS, tA[:H VNi i
Indutles ihe Service anNor Power Suppy up ro 500 Amperes, Ail
Circuits antl Two Insoe�tbn Trips Each Owelling Unil �$8�
Fee �
FOp OFFICE USE ONLY
11111111111111111111111111illlllllllflllll11111111
s/
m
O
,e�oay� �/a,s�o
IherThenRough-In: earlyNav Wili(_.
II I'�� O f I Vou must call ihe inspector when reaGy! I Da[e Reatly: I
I cerM1ty that I am ihe � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection ot the alecirical xrork at:
OccupaM � (1� � ,�
t7 /
f � � ' �P�YL�' '
PowerSUppl r AtlEress
�' �i
Eleclrical Con c[or / Compeny Name
�� Y1�S N.L`. ^l c�-r: �-
Mailing tlre5s (COnVac[or, Compeny or Owner Pertormino In
Phone
I [ lDJ / ° ! I " — I
BO�flD OF ELECTPodTY COPV INSTXUCTIOHS pl BRCK OF YELLOW COPV