P - 79959� REQUEST FOF ELECTRICAL INSPECTION
1 �^^ ��� Minnesota Board of Electricity
� ( b� 1821 Universiry Avenue Suite S428, Sain[ Paul, Minnesota 55704
� - (651) 642-0800 TTY/MRS 800-627-3529
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❑REMODEL ❑ADDITION ❑REPAIR
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Includes ihe SeNice arNor Power Suppty up to 50� Amperes, NI
Circutls and Two Insoecibn Tnos Each �welling UrN B� $&
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` ` FOF OFFIGE USE ONLY -
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I`O �- � H� �` I Vou must call ihe inspector when reaay! I Date Reatly: I
I ceeily that I am the �IICENSED CONTRACTOR ❑ COMPAIJY ❑ OWNER and herehy request inspection of the eledrkal work at:
� Power Supplier
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or Ow�l Pertortniig Instellation)
Phone
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