P - 79452.►! REQUEST FOR ELECTRICAL INSPECTION �
1�� 16 9 610 � Minnesota Board ot Eleciricity �'°`
� � • t- 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTYlMRS 1-500-6273529
www.e2echzcity.statemn.ux
NEW ❑REMODEL ❑ADDITION
ONE 8 TWO fPMILY OWELLINGS, EACN UNIT
Includes the Service anNor Power Suppry up ro 50� Amperes, NI
Circuits and Two Ins�ection Tnos Each Dwellino UnA �$&
totai tee is
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FOfi OFFlCE USE ONLY
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Re uest Date: Fough-in Inspec�ion Fequiretl? ❑ Yes No Inspection Other Than Rough-In: R Cy Now � Will Call
Vou musl cell �he Inspecla when reatlyl Dete Featly:
I ceNfy ihat I am the LICENSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection ot �he elecincal work at:
Jab!)tltlress (Sireet, Boa, or Route NoJ Ciy Zip Catle
� Power
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Phone