P - 80603REQUEST FOR ELECTRICAL INSPECTION
1 16 2 0 5 2 Minnesota 8oard oi Electriciry '"` `
� � 1821 Universiry Avenue Suite 5-728, Sai aul, Minnesota 55704 �-
.. :y,_: (651) 642-0800 TTY/MRS 1-80o-62 � �
www.electricity.state.mn.us Q� � �
I ONEW -6]
OF
❑REPAIR
IncWtles ihe Service anNOr Power Suppy up to 500 Amperes, All
Circuits and Two Inspection Trips Each Owelling U�it �$01
FOF OFFlCE USE ONIY
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Reques[ Dale: Rough-in Inspectqn iiequiretl? ❑ Ves ❑ No Inape
(� � �� �ou musY call �he irepector wTen ready! Date
I cetliy Mat I am the [�LICENSED CONTRACTOR ❑ fAMPANY ❑ OWNER
or
2907�
total fee is
- "z- 3 - �3
18 MONTHS
290�
�s�
and hereby request inspedwn of the electrical work at:
(0 3� S'�/- 39S
BORH� OF ELE4TRICITY COPY INS'lPOCTON6 ON BALK OF YELLOW COYY