P - 79988REQIJEST FOR ELECTRICAL INSPECTION �
„J, 1�p � 4 2 3 `* Minneseta Board of Electrio3y � ��
� � 1821 Univereiry Avenue Suite 5-128, Sa�nt Pa�,` Minnesota 55104
(651) 642-OSO� TTY/MRS 1-800-6273529
kvww.electriciry. sta[e. mrz. us
Identiry Ne work caveretl by ihis request: ,�ij/���� . � .,F_ p
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❑NEW ❑REMODEL ❑ADDITION ❑REPAIR Y n n V— A � n r. N!
CIFCUITS OP LESS
Includes tl�e Service anNor Power Supply up m 500 Amperes, All
Cimuics and Two Insoectlon 7rios Each Owellina Unit @$8(
� Iminimum total fee is $201 �j ��' � �
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FON OFFICE USE ONLY
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Request Date: Roughin Inspectim Required? ❑ Ves o Inspeclion Olher Than Rough-In: �ee0y Now 0 Will Call
`� �^ b � Vou musi call ihe inspectw when ready! Date Ready:
I cetliry that I am the�ICENSEO CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecfion of �he electncal work at:
Job AdGress (Streeq Box, or Rou�e No.j City 2io CoOe
�(C(Or�trectog C^om'pany or Owner Pertorming Installation)
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