P - 79483REQUEST FOR ELECTRICAL INSPECTION
1 Z 13 16 8 Minnesota Board of Electricity
� � 1821 Universiry Avenue Suite 5-128, Saint Paul, Minnesota 55104
., (651) 642-0800 TTY/MRS 1-B00-627-3529
www.elecireciry.state
Identiy the work coveretl by ihis repuesC — !�
❑NEW ❑REMODEL ❑AD�ITION ❑REPAIR �i. G� I U/C/�'!
Inclutles ihe Service anNor Power Supply up to 500 Amperes, All
Circuils antl Two Insoectan Tnps Each Dwelling Unit �$BC
Blectriral
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FOR OFFlCE USE ONLY � /f ��
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fleques[ Oate: qough-in Inspecibn ReQUiratl? ❑ Yes ❑ No Inspectlon ONer Than Rough-In: eedy Now � WII Call
a�/(� �D/ Vou must call t�e inspector when reaUyi pate Reatly:
I certify tha[ I am the CENSED CONTRACTOR ❑ COMPANV ❑ OWNER and he�eby request inspection of the eledrical wark at:
Job Atltlress �Street, z, o City Zip Cade
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t�p�EPENDABLE E��CTRIC, tNG.
M Coen Rapids. MN 5 4�� e���
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