P - 79363REQUEST FOR ELECTRICAL INSPECTION
1 3 5 0 6 3 0 Minnesota 8oard of Electriciry �
� � 1821 Universiry Avenue SuRe 5128, Saini Paul, Minnesota 55104
- :'.a�: (651) 642-0800 TTY/MRS 1-800-627-3529 / ��n � . :
� www.electricity.state.mn.us J I -
I ONEW �REMODEL ❑AWITION ❑AEPAIR .y/UgJ �f ���Jv�,OU y� 1y' ��� ! ��
Includes �he Service anNor Power SuDPIy up to 500 Amperes. NI
Circuils an0 Two Insoection Trios Each �welling UrN �$&
total fee is
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FOP OFFICE USE ONLY
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Fequart �1ate' J� Fough-in Inspectbn Pequired? ❑ Yes No Inspection OtM1er Than Rouqh-In: ❑ Reatly Now Will Gall
L � U� You must call Me inspector when reatly! Date Reatly:
I cert8y that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and herehy request inspedbn o� �he eledrical work at:
Ieec�ion I i ownsnip i,/ I Range I Fire No. I CotV/ly �
OccuPan[ -� :1 �.. Phone ��
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Center Point Energy MGCO
73562 Cenhal Ave Ne
Anoka, fy,[J 55304 l .
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