P - 79946�
1�173-232 �`
NEW ❑REMODEL ❑ADDRION ❑
OF
REDUEST FOR ELECTRICAL INSPECTION
Minnesota Board of ElectriciTy
1821 Universiry Avenue Suite 5428, Saint Paul, Minnesota 55104 �';
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www.electriciry.state.mn.us �j
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Includes the Service and/or Paver Suppy up ro 500 Amperes, All
Grcuiis and Two inspecibn TriFS Fach DweAing Unit �$&
FOR OFFIGE USE ONLY
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total fee is
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O/ You must call ihe inspec[or when reatly! Oate Ready:
I certity ihat I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecfion of the elechical work at:
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