P - 80621REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of ElectriciTy "
1� T 4 6�� O O 1821 Universiry Avenue Suita S428, Saint Paul, Minnesota 55104
,,. - (651) 642-0800 TTY/MRS 1-800-6D3529 l��� �
www.electricity.siate.mn.us � �•
THAN 50
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Ir�clutles the Service anNOr Power Suppty up to 500 Amperes, All
(minimum total tee is
2 � � �.e�''
a( POR OFFICE VSE ONLY �� �
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Fequest Date: Pwgh-in InspecGOn Requiretl? ❑ Ves No inspec�ion Olher Than Hough-In: ❑ Ready Now ill Call
vou must wll nie inspecmr w�en reatly! Da[e Reetly:
I ceNly that I am fie [�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspectlon of ihe elecfncal work at:
Job Atldrese (Sireet, Boz, or Route No.) Ciy Zip Code ,
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Seclion Tamship Range Fve No. Cou ,
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INC.
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E&OOWt�-13
OF EtECTHICRY COPY
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