P - 79372RE�UEST FOR ELEGTRIGAL INSPECTION
� �3 5 4 716 Minnesota Board of Elecfriciry
. � r � 1821 Universiry Avenue Suite S-728, Saint Paul, Minnesota 55104
�*'+'"- (657) fi42-O800 TTV/MIiS 1-800-6273529
www.etectriciry.state.mn. us
�, work cove�ed Oy this aquest.
❑REMODEL ❑ADDITION ❑
Ir�cludes ihe Service and�or Power Supply up m 500 Amperes, All
Cimuics and Two Inspec6on Trips Each �welling U�it � 58f
FOR UFFICE USE ONiY
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I I V I�C —{ i V J� I You must call the insp¢cior when reatly! j oeie a�ay� �
I certity that I am ihe�LICENSE� GONTRACTOR ❑ CCA4PANY ❑ OWNER and hereby request inspeclion ot the electrical work at:
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