P - 788091-4�7-336 �
., ., _. ,a..
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
�a�,� ad�_nann TTY/MRS 1-500-627-3529 www.electricity.state.mn.us
,,. .,
: ,�
� ;�.,�
� �,�
r
( IIII I� III II III (I Ill II III I� I I II III II III 11 � I
1 4 8 7 3 3 6 8
.,�3�3q
a�. �
Request Date: ' f Rough-in InspeGion Required7 ❑ Y� �No Inspection Other Than Rough-In: ❑Ready Now �Will Call
CJ
�- 3�3 � You must call the inspector when readyl Date Ready: ,
I ceRify that I am the �tICENSED CONTRACTOR ❑COMPANI' ❑ OWNER and hereby request iispection of tlie elecfical worlc at:
Job Site Address (Street eo�4 a Route I�b.) City LP �
n.,., i_,,., n.�,..._ . �iidl�� SS�f�2
l�
or
�035�
IN87RUC" dllS ON BACK OF YELLOW COPY � BOARD OF
-- -. /��;�.
Please Provide Two (2) Phone Number(s) Induding Area Code
�?�3 ) S'I4-�iSy )
a License Number Mas� Bectrician or Power Limited Tednician
� /�V/��� License Number
Phone (s)
(;ppY EB-0OOD7M74 8.1.2002