P - 79402REQUEST FOR ELECTRICAL 1NSPECTION
1� 3 4 6 4 7 5 ,� Minnesota Board of Electricity
� � 1821 Universiry Avenue Suite 5-128, Saint Paul, Minnesota 55104 :
._ �: (651) 642-0800 T7VlMRS 1�800-627-3529
www.electricity.statemn.us
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Identily ihe work cooeBa �y tnls request:
❑NEW ❑REMODEL ❑A�DITION ❑REPAIR
CIRCUITS
Includes tl�e Service anNor Power Supply up to WO Amperes, NI
Circvifs and Two Ins�ection Tnos Each Dwelling UnM �$8(
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iN ma� I in�mciM ihe electriral
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THIS INSTALLATION MAY BE ORDEREO Ul5connec7nu m nv� I:VMYLCIGU nn nu. �v �.�..�.�.,.,
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FOR OFFICE USE ONLY
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Peques� Date: PougFin inspectlon Requiretl? ❑ Ves ❑ No Inspecibn OIM1er Than Rou hd Now
g tly ❑ WiII Call
O��� Vou mu� call ihe inspector when ready! �ate ReaCy�.
I certify that I am N�J6ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby requesl inspeqion of the eledrical work at:
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EBd0001A / YN00 // BOAH OF ELEC pICITY fAPY $TqUCTIONS C
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