P - 79944RE�UEST FOR ELECTRICAL INSPECTION �
-' Minnesota Board of Electricity
��� 7 3� 2 2 7 tl 1821 University Avenue Suite 5-128, Saint Paul, Minnesoia 55104
. .... (651) 642-OS00 TTV/MRS 1-800�273529 : � �
www.elecfnciry.state.mn.us
; _>
en�ily ihe work covereA by this requesl: /�� A„ � aH L� ��j(fr�% (�� ��
I�� �NN v. f 7
INEW ❑REMODEL ❑ADDITION ❑R�PAIF
THAN 50 VOLTS
over
ONE & TWO hAMiLY UWtWIVIas, tIVGn Urvu
Inclutles ihe Service anNor Power Supply up to 500 Amperes, All
Cireuits arM Two Inspecfion Trps Each Owelling Unit � 381
See is
�d�
FOIi OFFICE USE ONLY
I IIIIII IIIII Il1N 11111111111N11 lilll lllil llll llll y�
x 1 1 7 3 2 2 7 B x /L �S �,,rp
Req)uest Dete: RougRin Inspection Requlretl? ❑ Ves � Inspec�ion Olher Than Rough-In: Reatly Now � Will Call
` 0 � You musicelliheinspectorwhen raetly! � Date Featly:
I certiy that I am iha �IC�SED CONTRPCTOR [�j CAMP�.NV ❑ OWNER and here6y request i�pedion of ihe eledrical work at:
eaa000u-ia �nn000
��iZ_ �
o.st"i�� I `%`7/03-7���7�
e�craicm corv
���
� 7.53-��
MST11UL110N9 ON BACK OF YELLOW COPY