P - 79643REQUEST FOR ELECTRICAL INSPECTION � I
2 21 2 9 6 Minnesota Board of Electricity
.�� � # 1821 University Avenue Suite S420, Saint Paul, Minnesota 55704 ���� '�
�€ay�� (657)642-OS00 TTVlMRS1-B00-627-3529 ���y�,/�
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I ONEW ❑REMODEL
OF LESS
Includes ihe Service anNor Power Suppy up to 500 Amperes, NI
Circuits and Txro Insoeclan Tnps Each �welling Unit �$BC
descnbed
fee is
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FOH OFFICE IlBE ONLY
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x 1 2 2] 2 9 E S x �.+�13i E/,.l�S G
Requeat Dffie: Roughtin Inspection Requiretl? Ves ❑ No Inspectim Other Than Rough-In' ❑ Reaoy Now Will Call
� O You must call ihe inspetlor w reatly! �ate Reatly:
I certity that I am 1he LICENSED CONTAACTOR ❑ COMPANY ❑ OWNER and hereby request inspection ol the electrical work at
�c. 19,�2-y�/-
or
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o�er ve rming �ngauanon� � Phone (� ��'^/
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