P - 79418REQUEST FOR ELECTRICAL INSPECTION -
1_��-��� d Minnesota Board of Electricity
1821 Universiry Avenue Suite 5-128, Saint Paul, Minnesota 55104 �
�� xa-�- (651) 642-OB00 TTY/MRS 1-800-6273529
www.electriciry.state.mn.us
Itlentify the work cmeretl by �his requeSC: ( / • %J 1
❑NEW ❑REMODEL ❑A�DITION �1REPAIR Ch"Zu�e � —["/j5.t_- �/"���_jJ�+L/
IncNdes the Service andlor Power Supply up to 500 Amperes, All
Circuifs and Two Insoection Tnos Each Dwellino Ilnit B$8[
total fee is
FOP OFFIGE USE ONLV
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Requ 0 e: ) - Rou9h'in Inspec�ion Fequiretl? ❑ Ves No Irepection Olher Than Ro -In: eatly Now � Will Call
�v You musl call Ne inspector when ready! Date Reatly:
I cetli that I am ttre,p�LICENSED COMRACTOR ❑ COMPANY ❑ OWNER and here y request inspection ot ihe elecirical work at:
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