P - 79434'— R�UEST FOR ELECTRICAL INSPECTION
1. 3 2 6 ��} 7 Minnesota tyard of Electricity
� � �p 1821 Universi Avenue Suite S428, Saint Paul, Minnesota 55104 �'��
(651)642-0800 TTV/MRS1-800-627-3529/��/'��
www.elecnicity.smte.mn.us i U .
Identiry thet wa9rk caveretl 6y this rcquest: �^
❑NEW [�HEMODEL ❑ADDITION ❑qEPAIR �'JU {/) �,'l�,v��� �j �C � I I �` / U U �
IAL0.RM, COMMUNICATION, REMOTE
CIFCUITS. CIRCUITS OF LESS THAN
Indudes ihe Service anNor Power Supply up to 500 Amperes, All
total fee is
O1 �
' FOB OFFICE USE ONLY �
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Requ Date; �j flough-in Inspeclbn Requimd7 ❑ Yes ' No Inspedion Other Then Rough-In: ❑ Reatly No Will Call
� O L/ You must call ihe inspeclor when reatlyl Date Reetly:
I cedify ihat I am the UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspeciion M ihe elec1ricai work aC
. i�t� nnn.osc �cnrewt eox. or Roule No] . .-. CiN � . � Zip Cotle �^^
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ELECTNICT/ COPY INSTPOCTONS ON B�LR OF YELLOW