P - 79615REQUEST FOR ELECTRICAL INSPECTION
1� 13 9-17 4 Minnesota Board of Electricity ,
1821 Universiry Avenue Suite 5-128, Saint Paul, Minnesota 55104 �:
��2� *"`°'�� (651)642-0800 TTV/MRS1�800-6273529
✓ rovww.electriciry.state.mn.us
entity ihe work coveretl by this request: ^ L 'IoGQ y�... �����J
fNtW ❑REMODEL ❑ADDITION ❑REPAIF�I[/l� R�WL ryM�v •� /"�� /��'
OF LESS THAN 50 VOLTS
aver
Indudes Ne Semce anNor Power Sopply up to 500 Ampere5, All
Cirouifs and Two Inscectlon Trms Each DwelNra Urxt � S9L
I hereM cerliN Ma1 I
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total fee is
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FOR OFFICE USE ONLY
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� l L LL" LWI �'/ou must call t�e inspec�or when ready! I Da[e Reatly: I I
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i ceRify that I am ihq,�LICENSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby request inspectlon of ihe elecMCal work at �
Job Address (Street, Boa, or Rout¢ No.) Cim n,. c..,e �
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Campairy
Phone
Master
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