P - 80431REDUEST FOR ELECTRICAL INSPECTION �
1 15 0 5 2 3 Minnesota Board of Electricity
rs � 1821 Universiry Avenue Sutte 5-128, Saini Paul, Minnesota 55104
(651) 642-OB00 TTVfMRS 7-800-627-3529
www.electriciro.sta[e.mn.us�. '����` �
Itlentiry the work covereU Oy t�ls requesl: �.� �_/�� ^
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❑NEW ❑REMODEL ❑ADDITION ❑REPAIR v�� � !
50
Inclutles the Service aMlor Power SuppN up ta 500 AmDeres, All
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FQR OFFICE USE ONLY
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Feq 0.v[e: AougJ�-in Inspec[iai Requi�etl? ❑Y� No Inspection Othe� Rough-1 ' Now Q Will Call
You must call ihe inspeclor when ready! Date Reatly:
I cetlify that I am ih ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and here y requesl inspection oi the electncal work at:
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