P - 79981REQUEST FOR ELECTRICAL INSPECTION ��,� ,
?17 9 16 3 Minnesota ryard o( Electricity
� � 1827 Universi Avenue Suite 5-728, Saint Paul, Minnesota 55704
(651) 642-0800 TTY)MRS 1-800-627-3529
wlvw.electriciry.state-mn.us
❑REMO�EL ❑ADDITION ❑
LESS THAN 50
InGudes ihe Senice ancUor Power Supply up to SW Amperes, All
CircuiM and Two Insoection Trips Each Dwelling Unit �$8I
¢VN-�a.rY-o�
$� f
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� FOH OFFICE USE ONIY
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Requesi Oate: Rough-in InspeCtion Repuiretl? ❑ Yes No Inspec�ion Other Than Rough-N: aedy Now � Will Call
�l ���/ You must call ihe inspeclor w�en readyl Da�e Ready:
I ceruy that I am the � LICENSED COMRACTOR ❑ COMPANY ❑ OWNEfi and hereby requesl inspecfion of the elecMtal work at:
Job Atltlress (Streel, Bax, ar Houte No.) City Zlp Cotle
7G�7-Cel�fi�a�i�lw.NE' F�/Otey�
Occ(�upa�nt /t /J
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Power Supplier
ElecMCal Comractor / Company Name
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Mailing AtltlrBSS (Cqnhaclor, Company or Own�
�777�00 025'7"`'�i�uei
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E60dO1A-13 ]/120W
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