P - 79417REQUEST FOR ELECTRICAL INSPECTION
1� L p 4- 9 3 8 �_ Minnesota Board of Electriciry
1821 Universily Avenue Smte 5-128, Saint Paul, MinnesoW 55104
(651) 642-OB00 TTV/MRS 1-800-627-3529
� www.electriciry.state.mn.us
❑REMODEL ❑AOOITION ❑REPAIR
OF LESS THAN
ONE 8 TWO FAMILV �WELLINGS, hAGH UNI I
Inclutles the Service anNoi Power Suppy up ro 50� Amperes, NI
Cimuils antl Two Insoectian T�as Fach Owelling Unit �$8a
ir
I � � FOR OFRCE USE ONLV
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'(j / Ve( � Vou must call ihe inspector when ready! � Date ReaEy: � I
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that I am ihe � LICENSED COM'RACTOR ❑ COMPANY ❑ OWNER and hereby request inspection ot ihe eleckical work af.
o.r.ES �' •., �:, .�. � I..7�3- _S7/-
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