P - 79952� REQUEST FOR ELECTRICAI INSPECTION
1�$ � 12 g Minnesota Board of Electricity
� � 1821 Uoiversiry Avenue Suite 5-128, Saint Pwl, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-6273529
www.electncity.state.mn.us
Identiy [he work covered Oy �his request (^� j/'^, � „S
❑NEW C7REMODEL ❑ADDITION ❑REPAIR V� ' '�����C�
CIRCUITS OF
Inclutles ihe Service anNar Power Supply up to 500 Amperes, All
n._...... ...a +�.�,, i..,..em�,�„ irinc Fa�h �wellino Unit �$BI
fee i5
FOF OFFIGE VSE ONLY
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Req1uest Oa�te: qou9h-in Inspection Fequiretl4 ❑ Ves o InspMion Ot�e� Than Rough-In: Reatly Now ill Call
f O Q� O� You must wll fhe inspecto� when reatly! Date Featly
I cerliy ihat I am ihe f�ICENSED CONTRACTOR ❑ COMPANY ❑ �WNER a�M he2by request inspection of the elecirical work at:
Job Atltlress (Streat, Box, oi Route No.) @ity 1 2ip Cotle
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or Uwner Penormin Ins Ila(onJ �
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BOppO OF ELECIPICITY COPV INSTHUCl10N5 ON 9ACK OF YELL