P - 78865REQUEST FOR ELECTRICAL INSPECTION
�� 3 6 9-113 Minnesota Board of Electriciry
1821 University Avenue SuRe S-128, Saint Paul, Minnesota 55104
(651) 642-0800 lTY/MRS 1-800-627-3529
www. electricity. state. mn. us
_ — — �—
FOR OFFlCE USE OIIILY
i «��ii ����� ���i� i���� �11►i ff��� ��� �3,�s
IN1111lilllll!
�E 1 3 6 9 1 1 3 4. �E �
�D.sa
Reque ate: Rough-in Inspection Required? ❑ Yes o Inspection OUrer Than Rough-In: ❑ Ready Now ill Call
��O W You must call the inspector when readyl Date Ready:
I certify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job ddress (St� _xyor ppute� P
� � � �- °��/r0L ZSSS�� y'
Section Township Range Fire No. County
Occupant Phone
� �'ow,�o � 3030�; : �63- �T,� �
Power Suoolier ...�__
ti cai Gontractor Company Nam� CoMr'act�o,r� nse�Number Master License Number
�i lT� �/��Tn�c G� C�`�3 is
Mailing Address ctor, Compan Owner Perfo g Ins a
! ��' e � �'• ,�� �%D/
Authorize igna ontractor om or Owner Performing Installaqon) Phone
.�- - 6�'/-?7�03��:
EB�00001A-13 7/1/2000 BOARD OF ELECTpICf1Y Cppy INSTpUCTIONS ON BACK OF YELLOW COpy