P - 79435RE�UEST FOR ELECTRICALIIVSPECTION � I
1 1, 9 g 7 7 4 Minnesota Board of Electricity
� � 1821 Universiry Avenue Suite 5428, Saint Paul, Minnesoia 55104 ��
(651) 642-DS00 TTY/MRS 1�BOP627-3529
• www.rlectriciry.srate.mn.us '�-�'
ItlentiN ihe work caveretl 6y this request: ��f /) / n A _
� pNEW ❑REMODEL ❑ADDITION ❑R£PAIR
ONE & TWO FAMILY �WELLINGS, �cn urvn
Includes ihe Service anNOr Power Supply up to 500 Amperes, All
Circuns and Two linoection Trros Each �welNng UMt �$8(
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Soeclal I�oectlon � 530 per Har �"�" 1ry$p&i1°"
S' I I cti n�$ 31 cer Mile � ���
..... �.,..�.� � rT�nn� nenv wF nRDFRE� DISCONNECTED IF NOT GOMPLETE� WITHSN 18 ONTHS _
FOR OiFlCE USE ONLY
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Iqequesi Date: Rouqh-in Inspection Required7 ❑ VBS ❑ No Irepection Olher Than Rough-In: eatly Now Q Will Wli
// ��Q • You mus� call the inspector wFien reatlyl �ate fleaNj:
I certity ihat I am ihe LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecAOn of ihe elecMcal woM at:
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