P - 79463REQUEST FOR ELECTRICAL INSPECTION , �
1-13 9-141 Minnesota Board of Electricity
a� '- 1821 University Avenue Suite 5-12Q Saint Paul, Minnesoia 55104 �;
Z�� (651) 642-p800 TTY/MRS t-B00-627-3529
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ItlenGty ihe work cavered 6y ihis request: 1 ��
NEW ❑FEMODEL �ADDIiION ❑REPAfR � �J` � ��� �
over
Includes Me Service anNor Pawer SuOD�Y up to 500 Amperes; All
OF
FOR OFFlCf USE ONLY
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LC L"' � LG(� � I You musl call Ue insPec
I cerGty that I am the�LICENSED COMRACTOR
� Occupant
Adtlress (COMracror, Company or
when reatlyl I Da�¢
❑ COMPANY ❑ OWNER
c��—
Fire No.
P�one
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and hereby request inspection ot Me elecincal work at: �
�
Master License