P - 79608�1-139-173 ��
�?3I
REQUEST FOR ELECTRtCAL INSPECTION s
Minnesota Board of Electricity
7821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104 -
(651) 642-�500 TTYlMRS t-8�0-G273529
www.elecFriciry.state.mn.us
ienbry the work coveretl by this request. ��� ����t �� ��
�W ❑REMODEL ❑ADDRION ❑REPAIR
I�clutles �he Service aMUOr Power Supply up [o SOD Amperes, NI
FOR OFFICE USE ONLY
I11111i11f1 iifllillllllliilif1ff11llllilii11111i1
No
''ll/"UN! IYaumustrafihe
oate
I cenity that I am ihe �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER
e��s �ss��
3n Rouoh-In: fl Readv Now WII C
and hereby requesl inspedion of the electriral work at:
BOMU OF ELEC1qILITY COPY INSTHUCTONS ON BACK OF VELLOW COPV