P - 79254^„ REQUEST FOR ELECTRICAL INSPECTION
1,310 0 4 5 Minnesota Board of Electricity
s • 1821 Univereity Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651)642-OS00 TTVlMRS7-800-6273529 �p?�2 -
www.eleCtriCiN.state.mn.ua' �» �
❑REMODEL ❑ADDITION ❑REPAIR
CIRCUITS OF LESS THAN 5� 40LTS
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Ir�cludes ihe Service anNor Power Supply up to 500 Amperes, All
Cimuik and Twn Insoection Trios Ear.h �w211ina Unit �$BI
' FOR OFFICE USE ONLY
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`� I� � Z Yau must call ihe inspecror when reatly� 0 t R Ey
I certily ihaf I am ihe � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecAOn ot ihe eleclncal work at:
Job Atltlress (S�reet, Box, or Route No.) City Zip Cotle
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� Occupant
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� Mailing Atldress (COnVactor. Company or Owner