P - 79969REQUEST FOR ELECTRICAL INSPECTION
T� � O ��� Minnesota Board of Electnciry
�� � . 1821 University Avenue SuHe 5-128, Saint Paul, Minneso�a 55104
* �� (657) 642-0800 TTV/MRS 1-800-627-3529
www.edectricity.state.rnn.us
Itlentiry ttie work coveretl Oy this request �J�
❑NEW ❑REMODEL ❑ADDITION ❑REPAIR vv� —/ /����� " C �
OF LESS THAN 50
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Includes ihe Service anNar Power Supply up to 500 Amperes, All
f,irruih and Twn Incraclion Triae Each Mte9ina Unil �$8(
total tee is
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I ���Il�I��I���I���I�II�I�I�����I��I����Ii����i��lll FOROFPICEUSEONLY
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R e� Rough-in Inspection Requiretl? ❑ Yes Inspectbn �thee Then ftough-In'. Nmro � Wal Catl
You musicallihe inspec�orwhen reatly! Dete Ready: C
I cetliy Nat I am t CENSE� CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspedion oi the eledrical work at
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Phone
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er Atltlres
u,raIXnOl l' ^Company Name � Contractor License N�
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s(COMracto Company or Owner Performing Inslellafion)
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7neture ConiraqQt Compsny er PeAorming Inslellation)
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MISTPUCTIONS q1 BACK OF YELLOW COPV