P - 79398REQUEST FOR ELECTRICAL INSPECTION
"��%�% +: Minnesota Board of Electricily
1�� L L- 9 0 4 k� 1821 University Avenue Suite 5428, Saint Paul, Minnesota 55104
(651) 642-�500 TTY/MRS 1-SOOfi27-3529 �/[ + �
' www.edecMcity.saate.mn.us �r �
IONEW ❑REMODEL ❑ADDITION �PAIR �L�',y/���///�G�
CIRCUITS OF LESS THAN
Indudes the Sernce andlor Pmver Suppty up to 500 Amperes, All
nircuits and Twn Insrection Trios Each Dwellino Unit �$8(
total fee is
� ` � FOR OFFlCE USE ONLV
111111111111lIIIIIlII! Illilllllllllllll�!lllllll ��- 5g� ,o,��
�c 1 3 2 2 9 D 4 Z 3t �
Request Date: Roug�-in Inspection Requiretl? ❑ Ves o Inspection OIYar Than fiough-In: ❑ qeady Now ill Call
�� / 0 must caN fie inspector wM1en reatly! Date Reetly:
I ceRiN ihat I am ihe ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecfion of ihe electnc2l work at:
At/2000
CWY " INSTPUC110NSONBRCKOFYELLOWCOPV