P - 80214REQUEST FOR ELECTRICAL INSPECTION
1� 13 9��� �J ` Minnesota Board ot ElecUiciry "
'� „; 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 '�
���� ' ` (651) 642-OB00 TTV/MRS 1-800-627-3529 , �'
- www.electnciry•.state.mn.us ����,�-�
�, work cove�ea �y tMS request CL.l � �!� ��� �� � _ _ �. ^
Jc.{ W �h.G� =�K...
❑REMODEL ❑ADOITION OREPAIR
Inclutles Ne Service anNOr Power Supply up to 500 Amperes, All
Circuits and iwo Inscection Trios Each Dwellirq Unk �$8(
LESS THAN 50 VOLTS
FOA OFFICE USE ONLY
illlllllllllll{N1811lIIII{IIIINIIIfl1{I{Iflllll 2���y 8s�o
—.fri� i ro� m�s�
I cemty that I am ihe �'LICENSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electncel work at:
� Occupam
Cqmpeny or Owner Petlortning Ins�allabon)