P - 80057REQUEST FOR ELECTRICAL INSPECTION �.
Minnesota Board of Electricity "
1-396-105 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(65f) 642-08001TY/MRS 1-800-627-3529
www.electricity.state.mn.us ' �
FOR OFFICE USE ONLY
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Reque���2 Rough-in I�pection Required? ❑ Yes l�No Inspection Other Than Rough-in: �Ready Now ❑ Will Call
Ypu must Call !he inspeda when ready! Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWMER and hereby request inspection of the electrical work at:
Job Address���, soX�R�t�, � c��y F��Y zp c«ie �3�
Section Township Range Fire No. County A�(A
�"�RF CHESTER R � Phone
Power Su lier E��V dress
Electrica! �ontr�c�r,/�Qm��n����� Contractor Lice�ns�e N�mbe3 Master License Number
tyt11YT tLtCTR 0088
Mai�in9 l.il]U ���C71'il�y�?A�e � P�IIV 1�%�1U�w�YIN �1 i�{
Authoriz ' nature (�rector, ompany or Ownar Perfortning Installallonj PFwne '
Q�i1 64�-2911
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY