P - 80453REQUEST FOR ELECTRICAL INSPECTION r
1 i 6 0 5 6 2 ��nnesota Board ot Electriciry �
� � 1821 Universiry Avenue Suite S-12B, Saint Paul, Minnesota 55104
� (657)642-0800Ty lMRS7-B00-6273529��
www.electrici .siate.mrt.us '^�'�
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C�RCUI75 OF LESS THAN 50 VOLTS
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indudes the Service anNOr Power Supply up to 500 Amperes, All
tolal fee is
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FOR OFFICE USE ONLV
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fleques[ Date: Rough-in Inspeclion Required? � Yes �nspec[ion Other T�an Roughln: atly Now � WII Call
You must call 9u inspca�w wne� reedy! Da[e Reatly:
I certily ihat I am the CENSED CONTRACTOR ❑ COMPANV ❑ OWNER and here6y request inspedion of ihe eledrical work at
Job Atltlress (Sireet, Boz, or Route No.) Ciy `� 2ip Cotle
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