P - 79259REQUEST FOR ELECTRICAL INSPECTION
1. ° 3-5 4�� p p � Minnesota Board of Eledricity �-���.
a t 1821 Universily Avenue Suite 5-128, Saint Paul, Minnesota 55104
-���+ (651) 642-0800 TTV/MRS 1-800-627-3529
www.electricity.sm[e.mn.us
Identity ih¢ woM cuvereA by this requesl: /�// ��( ,
L�NEW ❑REMODEL ❑A�OITION ❑REPAIR � G�%'�J /'1"/✓
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ONE & 71N0 FAMILY �WELLINGS, EACH UNIT
Includes ihe Sernce antllor Power Supply up to 500 Amperes, All
CircuiLS and Two Inscection Trios Each Dwellino Unil �$8f
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Request Date: p q Rough-in Inspection Requiretl? ❑ Yes o Inspec�ion O�her Than Rough-In: Ready Now � Will Call
I—� /—V �� You must caN �he inspectoi when reatly! pate Ready:
I cetlily ihat I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electncal work at
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