P - 79464REQUEST FOR ELECTRICAL INSPECTION
' I � � � � � Z ' ... Mmnesota Board of Electricity �'�
1� � 1821 University Avenue Suite 5428, Saint Paul, Minnesota 55104
°A�"'�� (651) 642-0800 llY/MRS 1-800-6273529
�'� 3 I www.electriciry.statemn.us '�' �
Itlentiry ihe work caveretl 6y this request: C�' ��� C��� p C 4 ��
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Y�NEW ❑REMOQEL ❑AD�ITION ❑REPAIR . ._ .
Inclutles �he Service andbr Power SupplY u0 10 SDO Amperes, All
Cimuim and Twn Insrenim Trios Each Dwellina Unit � 53C
total iee
iOR OFFICE USE ONLV
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Request D�at'e`: �qy� Rouglrin Inspec�ion Required? es ❑ No Inspecian Other Than Rough�ln: ❑ ReaEy Npv Will Call
2— J� �(/{Y / You must call t�e Inspector when reatly! Date Reatly:
1 ce�ity ihat I am the.�ICENSED COMRAC70R � COMPANY ❑ OWNER and hereby request inspecfion of the electncal work at:
,bb Atltlreea (StreaL Boz, or Route Na) Ciry Zip Cotla
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No.
Phone
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License Number
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