P - 80196REQUEST FOR ELECTRICAL INSPECTION
1 ��� ��� Minnesota Board of Electriciry
� � ` a��.. 1821 University Avsnua Su�te 5-128, Sainl Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529
• www.electriciry.saa[e.mn.us
Identify the work coveree 6y this request: .�- IY n fj' Q � n�� �.
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❑NEW ❑REMODEL QADDITION ❑PEPNR
OF lE5$ THAN'� VOLTS
Includes ine Sernce anNor Pmver Supply up to 500 Amperes, All
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ehvi ceniN ibal I insoectel U
rotal fee
describetl herein on �he tla�es staRtl: I
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FOR OFFICE USE ONLV
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Request Da[e: '/ �q Rough-in InspeIXion Requiretl? ❑ Yes Inspection Olher Than Rough-In: eaCy Now Q Will Call
I/'��7 - lJ I Vou mus[ cell ihe inspector when reatly! Da[e Reedy:
1 ce�ity t�at h am the�CENSED COIJrRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe elecMCal work at:
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?p/2000� BOAqp OF ELECTqitflY COPY INSTfl11CT10NS ON 6RCK OF VELLOW COPY