P - 80562' � REQUEST FOR ELECTRICAL INSPECTION
Minneso[a Board of Electricity
1-380-343 � 1827 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0500 TTYIMRS 1-B00-6273529
www.electricity.state.mn. us
� Identify U�e waA cweretl by ihis requesC
[w am ere e y'S ONE 8 T140
ve 200 Ampere �$10 Inclutles ihe
COMMUNICATION, REMOTE CONTROL, SIGNALING Qrcwis antl
I�II� I�I NNI llla IIIII�NM�I�qll I�I
` 1 3 8 0 3 4 3 2*
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EACH UNIT
290
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FOq OFFICE USE ONLY
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I certity that I am the L� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Atltlress (SVeet, eox, or Rou�e No.� ��M1, ,.. ,,. .
or
90AR� OF ELECTRICITY COPV
ANUKA