P - 79993� REQUEST FOR ELECTRICAL INSPECTION
1�9 0 311 � Minnesota Board of Electriciry
� � �t�, 1821 Univereiry Avenue SuRe 5-128, Saint Paul, Minnesota 55104
a�a (651) 642-�500 TTY/MFS 1-800-627-3529
, www.electriciry.statemn.us d
IONEW ❑REMODEL ❑ADDITION ❑REPAIR ��[J�jC.Q_, /��f'� (.J�� L.�`�----
Inclutles ihe Senice andlor Power SupDly up to 500 Ampe�es, All
total fee
on Ne tlates
y/.,3 . 03 �
` FOR OFFICE USE ONLY
IIN{IllIIINfNIIIIIIiIIIIININI{{{ II!{Illi III �o.s�
3� 1 1 9 D 3 1 1 9 x ��2..,/]
�oGp
Req poughin IwpMion Requiretl? ❑ Yes Inspection OMer Tha Rough In: tly Now � Will Call
Vou must call ihe Inspectot when reatly! Oa[e Reatly:
I ceRiy fhat I am th�CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and heredy request inspecUOn of the electrical wo�c aC
�ob��s (9'reet, Box, or Roxe No.� ^, � Ciry � �� Zip Cotle ,
L
Phone
� C
__ _ - - __,._. _._., _. _...._.. _.._.......,..._._.._.._..,
• � L17�/-�°�U
F6-00001A-13 l/12Wp BOIIHU OF ELECTq1qTY COPY INSTqUC�lOHS 0N BACK OF YE