P - 79955REQUEST FOR ELECTRICAL INSPECTION �
C% Minnesota Board of Electricity �� �
1� 19 0�� J f w, �82� Univereity Avenue Suite 5428, Sainl Paul, Minnesota 55104
a (651) 642-OS00 TTY/MRS 1-500-627-3529 ��
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. www.electriciry.state.mn.us � --n
IOentify ihe work covereA by this request: A `,�
❑NEW ❑REMODEL ❑ADDITION ❑REPAIR IN �/(X . �-f14C� i // /�
LESS THAN
Indudes �he Service anNor Pmver Supply up to 500 Amperes, All
total tee is
I Inscecletl the eleclrkal installatlon descnbed herein on
FOR OFFICE USE ONLY
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Pequeqt O�te: FaugRin Inspecibn ReQuiretl? ❑ Yes Inspectlon OUier T�en RougRln: dy Now � Will Cell
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/";J Vou must pll ihe inapector when reaCy�. pate Reetlq: � O
I cetlily that I am ih�CENSED CANTRACTOR ❑ GOMPANY ❑ OWNER and hereby request inspection of the electncal woik at
Job Adtlress ($I�t� Box, or Rou�e No.) n Cdy � � . Zip Cotle
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Li�
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a�h.t��ti <
ampsrrv or Own' ormina InstallF
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