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P - 79431
REQUEST FOR ELECTRICAL INSPECTION 1 3 3 6 812 ¢ Minnesota Board of Electricrty ' � � ,� :. 4821 Unive*sity Avenue Suite Sd28, Saint Paul, Minnesota 55104 *ao- �. (651) 642-0800 TTV/MRS 1-800-6273529 �� wwW.electriciN.stpte.mn.us �ntiry �he war�veretl Gy mis request: S� rneF1T � H fs. I ONEW �"qEMODEL ❑AD�ITION ❑REPAIR InGudes me Service anNar Power Supply up to 500 Amperes, All Circuit5 and Two Insoection Tnps Fach Dwellinp Unit �$8( ��^__ � � FOR OFfICE USE ONLY { I{IIN IIII{ {{{{I 4I{1{ 141{� IlII{ III{I lllll IIlI illl 3E 1 9 3 6 8 1 2 1 3t fleques[ ��je�e' Rough-in Inspeclion Require0? es ❑ No Inspe q—..J �' �� Vou must wll iM1e inspector whm ready! Date I cedify tha[ I am the r�'�ICENSEO CONTRACTOR ❑ CAMPANY ❑ OWNER Job AdGress lStret. Box, or Route No.) Cilr v� / ✓,� �/� ! /� �I/! �IJud �" /'it rQ.Ge� Sactbn TownsMP Re`ge �Fire No. G OccuP�� / �t U��A. lL P�one � � C orming Inslallation) � r / . _ L7 ,1 s� J" � (L� �s� fy: j �,}O� 6 /�. I and hereby request inspedion oi @e eledrical work at: Zip Co7e or�� P rming Inslallation) ' / ✓ Phane '�i�i�.�rsGG� 76-s�' � �� -S a a?S� BOAflD OF ELECTPIGirv COPY H15TFlICi101150N BpCK OF YEILOW COPY