P - 80616RE�UEST FOR ELECTRICAL INSPECTION �,
1 11� Q G 5 Minnesota Board of Electriciry
� � 7821 University Avenue Suite S-72Q Saint Paul, Minnesota 55104
* �-�� (651) 642-0000 TTY/MRS 1-800-627-3529
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Itlently ihe wark cavered hy ihis requesL T(�E A�.�� lJ. y S�" �(1�
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I �NEW ❑REMO�EL j�AD�IT10N ❑REPAIR
Ir�cludes ihe Service andlor Power Supply up to 500 Amperes, All
' FOP OFFICE USE ONLY
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Request Da[e: Pough-in Inspection Requiretl? ❑ Ves o Inspeclion OI
���(� ��' You must cell the inspec�or when roatlyl ONd fieflUy.
I ceRity that 1 am ihe �LICENSED CONTRACTOR ❑ G� PANY'-❑"OOCREF;�aa
Job Atltlress (Street, Bo*, a R ute NoJ City
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descnEed herein on the da
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requestinspecfion ofthe electncal work at:
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Phone
ConiraGOr License Number Master Lbense M
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