P - 79414REQUEST FOR ELECTRICAL INSPECTION
1 3 3 2 p 3� � Minnesota Board of ElectriciTy
� f 1821 Unive�sity Avenue SuEe 5128, Saint Paul, Minnesota 55�04
w.a-' (651) 642-0800 1T1'/MRS 1-800-627-3529
www.electriciryslate.mrt.us
Itlentify the work covere0 by ihis request L�D �p
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❑NEW IiREMODEL ❑A�DITION ❑REPAIR
THAN 5� VOLTS
Ir�cludes ihe Service anNor Power Supply up to 500 Amperes, All
Circwts arb Two InsDectlon Trips Each Dwelling Uni� � 58[
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FOR OPFlCE USE ONLY
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I certily that I am the [�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby requesf inspection ot the eleccncal work at
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Elec[tical Comraam / Comp nY ame Coniractor license Numbe� Mas�er License Number
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