P - 79422REQUEST FOR ELECTRICAL INSPECTION
� 3 2 6 g 6 7� Minnesota Board of Electricity
� � �� 1821 University Avenue Suite 5428, Saint P ul, Minne ota 55104
* ar (651) 642-0800 TTY/MRS 1-800-62 7352 9 �,��
www.eleciricity.state.mn.us
� ONEW
Wofk COVereO by ihis feque5t
�
Includes tl�e Servke andor Power Supply up to 500 Amperes, All
qRCUITS OF LESS THAN 5� VOLTS
���II��F�tIIII��I�IIIII���I�ll��l��ll IIII��I�I��I�OFflCE USE ON�Y
*
�nat �
total fee is
��5/�61 ap,s6
^� ��sP�uon Requiretl? ❑ Ves
�� �� b Inspection qhe� Than Rough-In: � qeatl
Vou musf call ihe inspgctor when reatly� Y�w Will Call
cenay that I am the o� R °y
� LICENSED CONTRACiOR ❑ COMPqNY
ob Atltlress (Street, Box, or qoute No.) ❑ OWNER antl hereby request inspection of ihe electrical work ac
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wer
INC.
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