P - 80593flEQUEST FOR ELECTRICAL INSPECTION _R
� Minnesota BoaM ot Elecincity ���
1-380-325 ,� , 1821 Universiry Avenue Suite 5-128, Saint Paul, Minnesota 55104 �'
�ssi� sa2-oaoo m�Mas i-aoo-ss�-sszs �_•
www. efectricity.state.mn. us .
Itlentily tl�e work coveretl Cy ihis �epuesl'.
❑.IOEW OREMODEL ❑ADOITION OREPAIR
CANTROL,
I III� hlll �hl h� Ilill ill I II� IIII I�I
over
Includes ihe Sen
Circui[s and Twa
rirvu irvsi
ta 500 Amperes, All
i Owellino llni� � $F
FON OFFICE USE ON�V
a��,s-o C�qr) i
290
1? ❑ Ves ❑ 1 Insp¢��ion O[�er Than FaugM1-in: I
>9i0 /
II QB��]�Q� I Vou must call Ihe inspec�or when reatly! Da[e Reatly: I
I ceRify ihat I am ihe L� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and herFiy request inspection of the elecirical work at: