P - 79971REQUEST FOR ELECTRICAL INSPECTION �
� _ O� � � - � ^ ^ Minnesota Board of Electricity
[[ �' 7821 Universiry Avenue Suite S-728, Saint Paul, Minnesota 55104
(651) 642-0800 TTV/MRS 1-800-6273529 �-�
. www.electnciry.siate.mn.us .
IDentlty Ne wotk coveretl by tAls request
❑NEW J�REMODEL ❑ADDITION ❑qEPAIR Gti�/^�G� NLl� �fiY/�
Inclutles ihe Service andlor Pmver Supply upto 50� Ampe�es, A{I
CircuiLS antl Two Inscection Trios Each Dwellino Unit �$8C
total tee is
FOIi OFFICE USE ONLY
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._. �.,__ ..." "_'__"__ .."'_�._.� r� ...... ni,, i..�..e..e..., imb, reo., a����n.i� f'I RaaCr Now f1 Will Call
I`��3`/ Ol I Vou must cell !M1e -n=cedor wfien reatly! I �ate Reatly: I
I ceNfy ihat I am the �LICENSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby reques[ inspection ot the elecirical work ai:
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my Name ConVaclor License Number Master ucense rvu
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Company m Owne� Petlortniig Ins�alla�ion)
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or vwner renorming inswnanon� • no��r '/ q p
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� BOARD OF ELECIXICrtY LOPY INSTpULTpN3 ON Bl�CK OF YELLOW COPY