P - 79482REQUEST FOR ELECTRICAL INSPECTION
1� G � 1-10 3 Minnesota ryard of Electriciry
1821 Universi Avenue Suite 5-128, Seint Paul, Minnesota 55104
:a.-�. (651)642-0800 TTYlMRS1-800-6273529 .,_._ �
' www.electnciry.state.mn.us
Itlemiry t�e work coveretl by ihis repues�: /' , /�
❑NEW �REMODEL ❑ADUITION ❑REPAIR (/(/ ._ �r�-�v` �
OF
ONE 8 TWO hAMILY UwtLUNlis, rJwn mvi i
Includes Ne Service and�or Power Supply up to 500 Amperes, NI
Ciraits and Two Inspection Tnps Each �welling UnB �$&
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total fee is
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Raquest Date: RougAin Inspection Fequiretl? ❑ Ves Irepection Olher Than ough-In�
�� Vw must call Ma'irepector when reetlyl Date Reatly:� ��7����7' ��(��
I certily ihat I am Ne ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and here y rN eqUest�inspediot
Job Adtlress Slreet, Box, o� Hpute NoJ CRy Zip Cp
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5 ion Townshio Ranae Fire Na. Counrv
� �ccupant
(1�
uner Periorming InsfelleEan��
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or pwn Peefortnino Insfellationl
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of ihe eledrical v.vrk at:
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