P - 80211REQUEST FOR ELECTRICAL INSPECTION ��
1 _ � � � - � � 7 � Minnesota 8oard of Electricity
7821 Univereiry Avenue Suite 5-�28, Saim Paul, Minnesota 55704
,_ �� (651) 642-OB00 TTY(MRS 7-800-627-3529
3� www.electriciry.stade.mn.us
!entity the work covered by!his �equest �� n�'� „y �.�. a•�{ p
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SNEW ❑REMODEL ❑ADDITION ❑REPAIR __
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Includes the Service andor Power SuGPIy up to 500 Amperes, NI
CireuiLS and Two Insoection Trios Each Owelling Unit @� $8[
total fee is $20j C
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. FON OFFICE USE ONLY
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x i 1 3_ 1 2 7 3� /P�?P / �Jr, $�
Request Dat¢: Rouah-in InspecMion Rcwuired? es I-1 No insoection Oiher Than qouoh-In: rl Reetiv Now WIII Cal
i r �-r ���.[�I�i � � �°u must call the inspecbr whm ready! � Data Reatly: �
I cerlity that I am the �CENSED CONTRACTOR ❑ COMPANY ❑ OWNER antl hereby request inspedion oi the electncal work at
Job Atltlress i5treet, Box, or Ram No.� CIN Zio Cotle �
�OccuPent
or Owner Pehortning installation)
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