P - 80213RE�UEST FOR ELECTRICAL INSPECTION
1 13 9 131 , Minnesota Board ot Elearicity '�
� r ° 1821 University Avenue Suite S-728, Saint Paul, Minnesota 55104
� � s�a: (651) 642-0800 ?TVIMRS 1-800-6273529
�3 www.electricaty.state.mn.us �=����
IOentify Uie wark coveretl by this �equest ��„ I+ � L Q�u I�� ��
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�iTNEW ❑REMODEL ❑ADDITION ❑REPAIR
VOLTS
Includes ihe Senice anNar Pmver Supply up ta 500 Amperes, All
C,ircuits aM Two Insnection hios Each DwellirA Unit �$8f
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FOR OFFICE USE ONLV
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R¢quest Date: Rough-in Inspection Required? es ❑ No Inspecibn Olher Than Rough-In: ❑ fleafly Nav ill :all
l'�' " � Vou must call t�e inspaHa when reatly! Da�e Reatly:
I certify that I arn the �ICENSE� CONTRACTOR ❑ COMPANV ❑ OWNER and he�eby request i�spaGion of the electrical work at�.
JaD Atltlress (Slree[ Boz, or Rouie Na.) City Zip Code
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