P - 80433REQUEST FOR ELECTRICAL INSPECTION
.,L � �� O�- 4 3 6 Minnasota Boartl of Eleqricity
)827 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104
(S51) 642-0800 TTV/MRS 7-800-6273529 -
_, www.electricth-siate.mn.us
( Identiry the work covered by this requesl: � � � �`f .�"� �'��'�,
' I ONEW ❑REM�DEL ❑ADDRION
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Ncludes the Service anNor Power Supply up to 500 Amperes, AI�
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R uest �ate: qougM1-in Inspection RBquired7 ❑ Yes No Inspaction O�her T�an qougRl¢ eatly Now Q Wil� Call
��, Vou musl call ihe inspqctor when reapyl Date qeatly;
I certify that I am ihe LICENSED CONTqACTOR Q COMPpNY Q OWNER and hereby request inspec6on of the electfical work aC
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