P - 79709�� � � __
REQUEST FOR ELECTRICAL INSPECTION
.'�� � � � O � _. Minnesota Board of Electriciry
� � � 1821 Univereiry Avenue Suite 5-128, Saim Paul, Minnesota 55104
" �a-�. (651)642-OS00 TTY/MR51-800.627-3529 ,/��
www.elecariciry.state.mn.us
over
Includes ihe Service anNor Power Supply up to 500 Amperes, All
Cireuits an0 Two Insoectlon Trios Each Dwellina Unit � 581
FOP OFFICE USE ONLY
I*IiIII IIIII IIII IIII! II l IIIII II II IIIII iIII IiII
Request Date: Rough-in InspecHOn Requiretl? ❑ Ves o InspE
Yov must call Rie inspacWr when reatly! Oate
I cedity thaf I am me �LICENSED WNTAACTOR ❑ COMPANY ❑ OWNER
Job Atltlress (Streeq Box, or Raute NoJ Cily
l�l9S �r�„a �e .U6 1=r�//ey
� Seceon I Township
� OccuPam
�
!� �aw�.
my or Owner Petlortning Insfallation�
total fee is
--� 3 I
2`�3oa dO,So �
and hereby request inspectbn of fhe electrical work at
Pho g�
/�
Numbx I Master License Number
EB-00001A-13 ]A/2400 r" BOAI�OFELECTqICT'COW INSTPOCTOXSONBALNOFYELLbNLOPY