P - 79941REQUEST FOR ELEC7RICAL WSPECTION
1 18 9 0 6 6 Minnesota Board of Electricity
a � 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55704
- (651) 642-0800 TTY/MFlS 1�800-627-3529
� www.electriciry.siate.mn.us
NEW ❑HEMODEL ❑ADDIDON ❑REPAIR
THAN 50
Inclutles the Service anNor Power SuppM up ro 500 Amperes, All
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Req�est Date: RouqM1-in Inspection Requiretl? � Ves ❑ No In m
sFecti Wiar ihan Rough-M: eaaY Now � Witl Call
���� �/ You must call ihe inspecro� when ready! Oata ReaEy:
� certity that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspectlon of the electncal work at:
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