P - 79441REQUEST FOR ELECTRICAL INSPECTION �
1�. 9 0 6 6 2 , Minnesota Board of Eleciricity
� � � 1827 Universiry Avenue Suite 5-128, SaiM Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627�529
www.electricity.state.mn.us � �{/�{� "
Itlentify the work cOVeretl by ihis request:
❑NEW �EMODEL ❑A�DITION ❑REPAIR
Includes the Service anNOr Power Supply up to 500 Amperes, All
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FOR OFFlCE USE ONIV
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Request Oate: Rough-in Inspeciron Requir�? ❑ Ves o Inspection Other Than Rwgh-In: ❑ Reatly No WII Cell
You must aX ihe inspecWr when reatlyl pate Reatly:
� certity that I am ih�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspec[ion of the elec[nral work at
,bb Atldress (Streel, Box. or Rwte NoJ c�ro -,._ .._�_
�•�nif tRe,iv-, `L��::i,.: � �i�O3—
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