P - 79965REQUEST FOR ELECTRICAL INSPECTION ,�q;e.
1'15 4 0 7 9 Minnesota Board of Electriciry '
� � - 1821 University Avenue Suite 5-128, Saint Paul, Minnesoia 55104 p, '-
�- - (65t) 642-08�0 TTYlMRS 1-8�0-6273529 , _gr �
. � www.electriciry.state.mn.us �
Ident�y the work covered by thie reques[ r��l _�d0 �T^� ,G�7L
� pNEW ❑REMODEL ❑A�DITION
CIRCUI7S OF LESS
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Inclutles ihe Service anNor Power Supply up �0 500 Amperes, All
f.imuits antl Two Insoertion Trios Each Owellino UnA �$&
rotal fee is'92Bj'.�
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describetl
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THIS INSTALLATION MAY BE ORDERED DISG�NNEGTEU �h rvU i Gumr�e � e� rn i nm w mvi� � na
FOq OFFlCE USE ONLV
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Request D Rough-in Inspection flequiretl9 ❑ Ves No Inspeclion Other TM1an Fough-In: eady Now Q Will Call
D vou r�ust ca�� me inspecror when readyi Da[e Feetly:
I ceN ihat am the ❑ LICENSED COfJ�RACTOR ❑ COMPANY ❑ OWNER and hereby request inspecfion of the electncal work at:
Job Atldress B[reeL Box or Roule No.l _ / CiN Zio Catle .
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