P - 81341REQUEST FOR ELECTRICAL INSPECTION
1����- 413 � MinnesoW Board of ElecVicity
1821 Uruversity Avenue Suife 5-728, Sairrt PaW, Mirmesota 557Q4
j� �,�, (651)642-OBOOTIYlMR57-80D-627-3529www.elecfricirystate.rrtn.us
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ONEW EMODEL ❑ADOITION/y❑ REPAIR Desaibe-usingthebxkoiMewhitecopyifnecessary-thexrorkcove�dbythisrequest.
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Inclutles tlie Sernce andlor Power Supply u0 � 500 Ampe�es, All
Grcui6 and Two InsDeciion Tri0.s Each Dxellinu Unit �$E
I Mreby cuffyNY I inspuEaO Ue NaYial instalaEan p¢smbeE h(e�re.in on iM tlffis sbtd:
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I certify Ihat I am Me �SICENSEO CONTRACTOR �COMPANY ❑ 04VNER arM he26y 2quest inspeclion of tlie elecirica! work at: