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P - 79352REQUEST FOR ELECTRICAL INSPECTION .`1� 3 6 0 10 7� _ Minnesota Board of Electriciry � � 1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104 s,.._�._'. (651) 842-0800 TTYlMRS t-800-6273529 _� . wwRV_eZectrtciN.Sfnie.mn.US � I ONEW ❑REMODEL ❑A�DITION ❑REPAIR Inclutles the Service and/or PowerSupply up to 500 Amperes, AIl rv.��n.. �,.n rw� i��w�n Trirm Fach �wellina Uni� �$8C total tee is slaled. l FOP OFFICE USE ONLY 1111111Ifilllllllllllllllll Illll Ifllllllllliil llll ,� ��7 ao � Request Date: qougMin Inspection Requiretl? ❑ Ves ❑ No InspeIXion Other Than Rough- � tly Now � WNI Call ' O Vou muat wll Ne inspector when reatly! Dale ReaEy: I ceitAy ihat I am the �ENSED CANTRACTOR ❑ COMPANY ❑ OWNER and Irereby request inspection af the electncal work at: JoC Atl�re's�5^reet, Box, ry-Route^ .) /! ^�' � /1 Zip Code i w 1 /f ei�a. Nw r Performing E640Wtp-13 --�aa i vrs i� BORPU OF ELEttBICffY COPY INSTHUC110NS pN BRCK OF YELLOW COPY