P - 80202REQUEST FOR ELECTRICAL INSPECTION
.1 16 8 3 4 4 •„ Minnesota Board of ElecVicity
� � 1827 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
r '"�. (651) 642-0800 TTYRviRS 1-500-627-3529
www.electricity.slate.mn.us
Itlentiry IDe work coveretl 6y this requesl: ` ' /���/� /
❑NEW ❑REMODEL ❑AODITION �REPAIR ��� �� �/�'V"'�'�'� � V � � ��
Includes tl�e Service anNOr Power Supply uD �0 500 Amperes, All
Cimuits and Two Insoection Trios Each �wellina Unit �$BO
FOP OFFICE USE ONLY
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n /yuw� oa�n: nougnm mspecuon HeqWretl? �J Ves �ifNO Inspe
//`��� O/ Vou musl call @e inspaclw when reatlyl Date
I cemfy ihat I am the,,�LICENSED COMRACTOR ❑ COMPANY ❑ OWNER
Job Atltlress (Stree�BOx, or Paum; o.) ��� �hy �
o,
BOAND OF ELEGTHICIrv COPY
fee is
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Will
and hereby requestinspection ofihe elechical work at: I
Zip Catle
.lr��, J�s 43 a.
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INS�PUCTIONSONBACK FYEILOWCOVY