P - 79461REQUEST FOR ELECTRICAL INSPECTION �
� � � O � � � Minnesota Board of Electriciry °`
. � � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
*- �ssi� saz-oaoa TTYrMRS 1-800-627�529
www.electriciry.state.rron.us �
Identiy Ihe wark cwerttl by lhis requeST. _�� � � ,/���
I�NEW ❑REMO�EL ❑AWITIINJ ❑REPAIR
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Inclutles �he Service anNor Power Supply up to 500 Amperes, All
Cirmiirc aM Twn Insmr.finn Trins Each Dwellino llnit �$8[
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(minimum total fee is $20) � �
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FOq OFFIGE USE ONLY
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pe`quest �ate: qough-in Inspectlon Requiretl? Ij(Ves U No Inspecllo� Olher Than Rough-Ire U Reatly Nav �NIII Gall
r a��a � O� You must ca0 ��e inspectw when featlyl Date Reatly:
I certify that I am ihe �LICENSED COMRACTOR ❑ COMPANY ❑ OWNER antl hereby request inspecfion M ihe electrical work at:
Job Atltlresa (Street, Bo/x/ or Route No.) /� n Ciry �^ / 2ip, �C-o�de�/' ^�
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Mailiig Atltlress (COniractoq Compairy or Owner Pertorming Instellation)
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EIECTFICRY LOPY INSIRUCTpNS ON BACK OF YELLaW