P - 79265REQUEST FOR ELECTRICAL INSPECTION
` • � • � � � � � . Minnesota Board of Electricity
j� 1 � 1821 Univereiry Avenue Suite S928, Saint Paul, Minnesola 55104
� (651) 642-OS00 TTY/MRS 1-500-6273529
www.electricity.siate.mn. us
IAentity ihe work coveretl 6y this request: * /1_T�,�,� r/ �J /yh� �—yp
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❑NEW REMODEL ❑AODITION ❑REPAIR � �OO /r'��/� F/'«iI'�/S•--�Y�¢/ �pS49C .
ONE & TWO FAMILV �WELLINGS, tAGH UNII
Indudes the Sernce aMlor Pmver Supply up to 500 Pmperes, All
Circuits and Two Insceclion Trips Each Dwellinp Unit �$8(
total fee is
a � FOp OPFICE USE ONIY ^
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x 1 1 7 4 9 2 5 6 x ,�'d°
Request Dat : Rough-in Inspeclion R¢quiretl? ❑ Y¢s o Insp¢qion Othar Than Rwgh-In: ❑ Ready Now ill Call
Up� Vou must call �he inspeclor w�en reetlyl Data Reetly:
I certi that I am the ICENSED CONTRAC'fOR ❑ COMPANV ❑ OWNER and hereby reques[ inspeclion of the eleqncal work at:
Job Atltlress (Streat, Boz, ar RoWe No.) Ciry Zip CoOe
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Section Towns�ip Ra�a Fire No. u _ _
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Supplier Atltlress ` � �/ �
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al Conbeclor / Company Na Conlractor License Number Mazter License Number
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or Owner Pertartning Installation)
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