P - 79401REQUEST FOR ELECTRICAL INSPECTION
� Minnesola Board of Elechiciry � �
�~ 3 4 6- 4 7 4 1821 Universiry Avenue Suite 5428, Saint Paul, Minnesota 55104 _
a�,�",""�,: (651) 642-0800 n1'/MRS 1-800-627-3529
www.electricaty.state.mn. us
I DNEW ❑REMODEL ❑ADDITION ❑REPAIR
OF
ONE & Iw0 FAMi�r uwtw��a, rh�n m.��
Includes the Service anNw Parer Supp�y up to 500 Ampe�es, AI�
�.._..,.....,. r,.r i��„e,a��� inns Each Owellina Unil �$�
total fee is
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Request Date:(j Rouqh-in InspecXOn Required? ❑ Ves ❑ No Inspeclion qher Than RougM1-I . eatly Now � Will Call
�� O � Q� You must call Me inspectw when reathf Date Reatly:
I cenBy that I am�tl�[�ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elearical work ak