P - 79597REQUEST FOR ELECTRICAL INSPECTION � �'
1-1 � 9� 1 f Q Minnesota eoard of Electriciry '
� � 1821 University Avenue Suite S-12$ Saint Paul, Minnesota 55104 4
, ' � (651) 642-0800 TTYlMRS 1-800-6273529 _ , `'
� ��3� wiaw.efectriciry.state.ran.us
Itlemiry ihe work caveretl 6y ihis requesL J^�� ����I �� �y .� r.� /)
s�i� !i 7_Y� V�...�.
�W ❑REMO�EL ❑ADDfTION ❑REPAIR
inclutles U�e Service anNor Power Supply up to 500 Amperes, 0.11
FOfl OFFICE U8E ONLY
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����LCU ��%I I �°u must call �he inspecmr when reaay! I Oate Ready: �
I cetlily that I am Me�CENSED CONTRACTOfl ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Htltlress (SbeaL Box, or paWe NoJ Ciry _ Z�p Cotle
� Meiling
�m� or pyMr Pe orming InstallationJ
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]l1/2000 BORHD OF ELEC
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