P - 79468REQUEST FOR ELECTRICAL INSPECTION
1 13 9 14 6 Mmnesota Board of Eleciricity
� � 1821 Unrversiry Avenue Smte 5-t?8, Saint Paul, Mionesota 55104
���' � � (651)6420800 TTYlMFS1-S00-627-3529 ��
www.electriciry.szatema.us
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❑REMODEL ❑ADDITION ❑flEPAIF
INJE & PNO F0.AAILY �WELLINGS, EAGH UNI7
Inclutles ihe Service anNor Power Supply up to 500 Amperes, All
SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$eC
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FOfi OFFICE USE ONLY
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Request Date: 'M Rough-in )nspeciion Requiretl? es ❑ No Inspeciqn Other Than Rough-In: ❑ Reatly N ill Call
2—� _! V!Y 1 You must call t�e inspNOr when reatlyl Da[e Reetly:
I certify the[ I am the�LICENSED COMRACTOR ❑ COMPANV ❑ OWNER antl hereby request inspection ot Ihe ekclrical work aL
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