P - 79588REQUEST FOR ELECTRICAL INSPECTION .,�
1� 13 9�.L V p Minnesota Board of Electricity
�a - 1827 Universify Avenue Suite S-128, Saint Paul, Minnesola 55104 �.
�?31 �ssi� sa2-osoo rrvmaRS i-aoase�-as2s
www.electricity.state.mezua�
Identify tlu wo�k covered by iMS request'. � �� � � � ^ �, � �6. /V�,��"'� �
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�EW ❑REMODEL ❑ADDITION ❑REPAIR .
Includes the Service anNor Power Supply up ro SOD Amperes, NI
Circutls antl Two Insoection Tnps Fach Owelling Untl �$BC
fee is
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FOR OFPICE USE ONLY
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Reques� Date: Rough-in Inspetlion Requiretl? Ves ❑ No Nspectbn Other Than Roogh-In: ❑ qeetly Nwv ill Call
2'� You musi call the inspeclor w�en reetly! Date Reetly:
I cemfy t�at I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecfion of the elecNCal vrork at:
Job Atltlreea (Siree( Box, or RWte No.) CiN Zip Coda
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