P - 80623REQUEST FOR ELECTRICAL INSPECTION ,�,�
� 1 10 8 5 9 9 Minnesota Board of Electriciry °°
� � 7821 University Avenue Sui[e S-128, Saint Paul, Minnesota 55104 �,,;
(651) 642-0800 TTY/MRS 1-800-627-3529
x�ww.electriciry.state.mn.us �
� �NEW ❑REMODEL ❑A�DITION
ONE & TWO FAMILY DWELLINGS, EACH UNIT
IndtiCes ihe Sernce ardlor Pmrer�Supply up to 500 Amperes, All
Circuits and Tvro Insceciwn Tnos Each D,vellina Unit �$8C
total fee is
290��
I he:em caroN ihat I inscec4M �he elecincal installation desaibed herein cn Ne tlares
Q �d
Illllllllflllllllllllllll�i�l I�II�III�� �p OFFICE USE ONLY �� ��1 +���
f 2�o5s
I f\� V 1 � i LJ 1 � Ya must call ihe inspeciw when reatly! I p� q p�,� I
I cetlify that I am the � LICENSED CONTRACTOR ❑ COMPANV ❑ OWNER and here6y requesl inspection of the elearical work at
Mailing
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