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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 �-��� FOR OFFlCE USE ONLY � /f �� _��_. ___. —__—. � .)v 1111111Ni111111filllllllllllllllilillii{II11111 �'����°' x 1 2 1 3 i 6 B 6�c 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 ,��[-r!� �.�i��iJ.�nie . .v�. .S.- , -rc-9'r� r_ . // � Phone t�p�EPENDABLE E��CTRIC, tNG. M Coen Rapids. MN 5 4�� e��� Phone Y � � r irv✓ i.� / •.� v ]H2D00 BORND OF ELEC1111CrtY COPY MSTPUCl10N5 ON BACK OF YELLOW COPY