P - 80197. REQUEST FOR ELECTRICAL INSPECTION
1 ��� ��� Minnesota Board of Electricity
� � � 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
' y'� (651) 642-OS00 TTY/MRS 7�800�27-3529 .
I www.etectriciry.state.mn.us
I �NEW ❑REMODEL ❑ADDITION ❑REPAIR
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InGudes the Sernce anNOr Power Supply up to 500
total fee is
All
Ipecial Irepection �$.31 perMile C, g�/%°i I
iHIS INSTALLATION MAY. BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
� FOR OFFICE USE ONLY
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Rough-in Inspeqion Requiretl? ❑ Y¢s Inspectian plher Than Rough-in: ady Now � WII Cell
Vou musf call ihe inspector w�m reatlyl Date ReaRy:
�I ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and here6y request insped'ron of ihe eledrical work at:
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