P - 79957REQUEST FOR ELECTRICAL INSPEC710N
1 15 3 7 7 5 Minnesota Board of Electricity ' " �
� � 7821 Universiry Avenue SuRe S-128, Saint Paul, Minnesote 55104
- (651) 642-0800 TTV/MRS 1-800-6273529
- www.edecMcity.sdate.mn.us
Itlentity Ue work covereA by �his raquest \/ j /J ,, /'
❑NEW REMODEL ❑A�OITION ❑REPAIR����r �+�7 + Cave%�eG� /'�7�q'C�l
OF
BE
over
Includes [he Service anNOr Power Supply up to WO Amperes, All
Circuits antl TWO Inspection Trips Each DwNling UnA �$8(
��ls 7`2�
total tee is
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FOP OFFIGE USE ONLY
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Request Date: / Rough-in Inspaction Requiretl? Ves ❑ No Inspection Other Than Rough-In: ❑ Feady Now ill Call
r�— � 3� � f You must caN fie inspeclo� when �eatlyl Dale Reetly:
I cerAy ihat I am ihe LICENSED GONTRACTOR ❑ COMPANY ❑ OYVNER aM hereby request inspection of the eleciricai work at:
Jcb Atlaress (S�Yaet, Box, or Rou[e No.) Ciy Zip Cotle
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Atltlress
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