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Itlentiry the wark covere0 Uy IDis request
❑NEW ❑REMODEL ❑ADOITION
CIRCURS OF LESS THAN W VOLTS
REQUEST FOR ELECTRICAL INSPECTION .�
Minnesota Board of Eledricdy ��:.
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MPS i-B00-627�9529
WWW.fIfC[YlCZI)'.StR1&!]En. US
7�1,i � i � l9�Jg „ , ,
Includes ihe Service and/or Power SuppN up to 500 Amperes, All
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FOH OFFlCE USE ONLY
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��`�_ ���' t�� I Vou musl call Ne inspena when reatlyl I Date Reatly: � I
I certify that I am (he LICENSEO CONTRAC'fOR ❑ COMPANV ❑ OWNER and hereby request inspedion of ihe eledrical work at:
or Owner Perfarming
OF ELECIPICRY COW
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