P - 79365RE�UEST FOR ELECTRICAL INSPECTION
�"� ^ 0 O�� . Minnesota Board of Electricity
� b � 1027 Univereiry Avenue Suite 5428, Saint Paul, Minnesota 55104 3�
� . . s- (657) 642-0800 TTYlMRS 1-800.627-3529 �
wwW.edectriCtiy.state.mn.us
❑REMODEL ❑ADDITION ❑FEPAIR
ONE 8 TWO F�+1ILY UWtLLIrvuD, en�n unu
IncluBes the Service anNw Power Supply up to 506 Amperes, All
CircuRs and Two InsO�an Tnps Each Owelling Untl �$BC
�N_ /LY��.—
THIS INSTALL.ATION MAY BE ORDHPED UI��%urvlvtt:� i
FOR OFFICE USE ONLY
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Request Date: Rough-in Nspection Requiretl? ❑ Ves ❑ No
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6a8a �o,so
m Rough-In: atly Now � Will Call
I��� Q �'./OC � You must call t�e inspedor w�en readyl I pale lieatly: I
I cerety ihat I am the�C(CENSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection ot the electrical work at:
��619 Coon RaQids Blvd_ NW
Phone
�'D� -94��
Installalion)
BORPU OF�OPY I��IHSTHUCTI� � BAL� �OCO I