P - 79407REQUEST FOR ELECTRICAL INSPECTION
1 � O� ��� Minnesota Board of Electricity
� � 1821 Universiry Avenue Suite 5428, Sainl Paul, Minnesota 55104 ?
� (651) 642-0800 TTYlMRS 1-800-627-3529
www.edectriciry.state.mn.us
IOeMiry the wark coaered hy ihis requesC ' L� !� ��,� : �(�(�('''v��++"�.c���''' sss"�-�yy�``��'''��(� �y
�ryNEW ❑REMODEL ❑ADDITION ❑REPAIP� /LC! ° '��%�� ��1:�
Includes ihe Sernce antllor Power Supply up ro 500 Nnperes, All
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rFOR OFPICE USE ONLY
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I�L �' /�� o L I Vou must call ihe inspeclw wM1en reatly! I Date qeatly: �
I ce�tity �hat I am ihe � LICENSED COMRACTOR ❑ COMPANY ❑ OWNEfl and hereby request inspection ot ihe elecirical work at:
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Seciion Township R irq.11o. Coumy .�! I
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