P - 79700REQUEST FOR ELECTRICAL INSPECTION -
1� 18 9���} � Minnesota Board of Electricity
{�*� 1821 University Avenue Suite 5-128, Sairn Paul, Minnesota 55704
(651) 642-0800 TTY/MRS 7-800-627-3529
. ' wwtiv.electriciry.stute.mn.us ..
■ 'I1I:1:I�N
REMODEL ❑
OF LESS THAN 50 VOL
Includes the Service anNor Powe� Suppy up to 50� Amperes, All
Vl�
FOP OFFlCE USE ONLY
I*NIII IIIIIIIIII Illf I IIIIIIIlllllllllllllf IIIIIII
I� `� -^ �% � I V°u must cell the inspx[ar when reatly! I Date
I cerlity that I am the�ICENSEO CANTRACTOR ❑ COMPANY ❑ OWNER
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ar Than Rougtrin:
iee is
1 herein on Ne dates sq�etl:
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and hera6y request inspectbn of the eleqrical work aC �