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REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 Universdy Avenue Suite S-12B, Saint Paul, MinnesoW 55104
(657) 642-0800 TTYlMRS 1-800-627-3529
www.e2ecmicity.state.mn,us
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Includes Ihe Service anNOr Power Supp'y up to 500 Amperes, All
(:irri�im aM Twn Inene�tim Trin.� Each �vfeAina UIIII �$BC
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I certify that I am tha�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection ot the electrical wurk at:
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