P - 79427REQUEST FOR ELECTRICAL INSPECTION y,e
1 3 3 8 2 3 g Minnesota Board of Electficity
� � 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
aer-�. (657) 642-OS00 TTYlMRS 1-800.627-3529 ��:..
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Itlenfiy tAe wark coveretl by ihis reques�:
❑NEW ❑REMODEL ❑ADOITION ❑REPAIR
CIRCUITS OF LESS THAN 50 VOLTS
Inclutles ihe Service and/or Power Supply up to 500 Amperes, All
CircuMs antl Two Insoection Tnos Each 6,vellina Unit @ EeC
I he�eW artiH IM1et I
FOp OFi10E USE ONIY
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I I ceRify ihat I am +n°�NSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby request inspectlon of ihe electncal work aC
Fire
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]I1200U 9MIiD OF ElEG1HICITY COYY INSTNUCTIONS ON BPCK OF YELLOW LOPY