P - 79466REQUEST FOR ELECTRICAL INSPECTION
1 13 9 14 4 � Minnesota Board of Electricity �
e � ��- 1821 Universdy Avenue Suite S-128, Saint Paul, Minnasota 55104
73 � _ (651) 642-0800 TTY/MRS 1-800-627-3529
www.elecariciry.smte.mn.us '�ft
Itlemiry t�e wark cavered 6y this request�. ��� ����C ���
�NEW ❑REMODEL ❑ADDITION ❑REPAIR
Inclutles the Service anNor Power Supply up to 500 Amperes, All
CimiMs and Twn Inmarfinn Trins Each Owellina Uni� �$BC
VOLTS
FOp OFFICE USE ONLV
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tat21 fee is
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I� L� J ��( I Vou must call �he inspector when reatly! � Oate ReeOy: �
I cetlify ihat I am thele LICENSED CONTAACTOR ❑ COMPANY ❑ OWNER a� hereby request inspeaion of the elecMral work at
Job Atltlress (SYreeS �� or Poute No.) �_ ay Zip Code
Range � Fire No.
Atltlress
or
Phone
�n� (�w,�� r 0 ner Petlorming Instal '. � Phone
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�tl2UW BO�HO OF EIECTHIdTY LOPY
Master License NumOer
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