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❑REMODEL ❑ADDITION ❑
THAN 50
REQUES7 FOR ELECTRICAL INSPECTION ,v„=
Minnesota Board of Electricity
1827 Univervtiry Avenue Suite S-028, Saint Paul, Minnesota 55104
(651) 642-0800 TTVlMRS 1-800-6273529
wxryr.electriciry.state.mn.us ' �- �'
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Includes ihe Service anNor Power Supply up 10 500
CircWts and Two i�soeaion has Each Owellir
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FOR OFFICE USE ONLY
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tL�4(/ �l.4pr You musl call t�e�insP�a wM1en reatlY! Da[e FeetlY:
I cediry tha[ I am the �CENSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecfion M the elec[ncal work at:
Job Atltlress �Stree�, Box, or Roule No.� Ciry Zip Code
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