P - 79980REQUEST FOR ELECTRICAL INSPECTION �,�
��=19 0- 6 3 7 Minnesota Bryard of Elearicity
1821 Universi Avenue Sutte SY28, Saint Paul, Minnesota 55104 �?
_ � *�� (657) 642-0800 m�MRS 1 800-6273529 �� ��
www.electracary.state.mn.us �
Identiry the v+o�k coveretl by this request: ( /�/,Sq ^^ n�y
❑NEW 04MEMODEL ❑ADDITION ❑REPAIR �� liC��J� `✓/_� / / V ��"�
LESS
Includes the Service anNor Power Supply up to 500 Amperes, A��
Circuits and Two Insoection Trips Each �welling Unit �$8(
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FOH OFFICE USE ONLY
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ReQuIes/t Date: / Rough-in Inspection Requiretl? ❑ Ves No Inspection Olher Than RouqM1-In: ❑ Reatly Now ill Call
( G � "' Q( You must ceil the irvspector when reetly! Da[e Reatly;
I cetlify that I am the LICENSE� CONTRACTOR ❑ COMPANV ❑ OWNER and hereby request inspectbn oi the electrical wu�k at:
Job Atltlress (Street, ox, or oute NoJ Ciry Zip Code
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Seqion Township pange Fire No. Counry _
� Power
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BO�qD OF ELECTPICRY COPY
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