P - 79394RE�UEST FOR ELECTRICAL INSPECTION
1�' 3 0 5 9 8 3 � Minnesota Board of Electriciry
� � 1827 University Avenue Suite 5-128, Sainl Paul, Minnesota 55704
a:. (651) 642-0800 TTY/MRS 1-SOP627-3529
wwrn.elecMciry.siate.mn.us
Identiy ihe work covereA by this request /�y� �
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❑REMODEL ❑AODITION ❑REPAIR
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service anNor Power Supply up to 500 Amperes, All
CIRCUITS OF
PDX OFFICE USE ONLY
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electnral
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nep/uest uate: rt \ nougn-in inspecuon naquiretl? �J Vas �,NO Inspectlon OMer Than Rough-In: [4 Featly Now � WII Call I
( O�a. pZ—y p� Vou must cal� Ihe inspecbr when ready! Oate Reatly:
I cehify �ha[ I am the'�] LICENSE� CONTRACTOR ❑ COMPANV ❑ OWNER and herehy request inspection of ihe e�ectrical work at:
Job AdCress (S[ree6 Box, or Route No.) Ci Zi Code
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Power SupPlier
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Company or Owner Petlorming Installation)
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Phone
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rscmr licensa Number Master License mber
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