P - 78833REQUEST FOR ELECTRICAL INSPECTION
1��} J�- 4 2 3� Minnesota Board of Electriciry -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
.. (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
IIN II III II III I I I II I I III II (II I I III II I I I n IN I�
14584239
���
�a•s v
Request Date: Rough�n Inspection Required? ❑ Yes LJ No Irupection Other Than Rough-In: ❑Ready Now ❑ Will Call
�'�� �b3 You must call the inspectw when ready! Date Ready. ,
I ceitify that I am the `� UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecUon of the electrical woric at::
Job Site Address ( Bw4 a Route No.) C' Zip Code
�1 yl 1�anda�� ,�r. ✓V� �Yi�d ��
Sedion Township s� Range Fire No. County/�� j�
.�-- ._ _i � . .! f— — TT Yl 71 // � i
o f�3) S�1- 03 ( )
rv� Sup rer Power Supplier Address
�C C�'L
/ Company Name ConVactar License Number Master Electriden a P
� � / � . License Number � �
ailin Address (CoMractar. o�v or Owner Perfaminn InstallatioN _
my a
on
I ����-S�G-�LPS �I
eoaxo oF e�cTwcin coav ee-0000u-u e.�. zooz