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Idemity �he work coaered by this repues�. \ ,
❑NEW ❑REMOOEL ❑ADDITION �RE
REMOTE
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.eleciricity.state.mn.us
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Outdoor LioMino Sta
InGUdes the Sernce anNor Pmver Supply up to 500 Amperes, All
1 her¢�v oe�ldr I�at I lnspee�etl Ne eleolicel
[otal fee is
1IlIINIIIIIIIIIIillll{NIIliIIIllllllllll IIfIINI FOR OFFICE USE ONLY
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�e es� Dat � O RougFin Inspec�ion pequiretl? ❑ Yes No Inspection qher Than Rough-In: Reatly Now � Will Call
You musi catl Ne inspeMOr when ready! Ddte fleacty: l
I ceNy that I am tha LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electnral work at
J��ntldress (Streat, Box, or Raule No.y� Ciry zip Coae
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]f1f20W BOPHD OF FLELTPoCITY CppY INSTqUCTIONS ON B4CK OF YELI