P - 80212REQUEST FOR ELECTRICAL INSPECTION
1� 1��-13 2; Minnesota Board of Electricity
1821 Universiry Avenue Suite 5428, Saint Paul, Minnesota 55104
� �^ � � �`ai� (651) 642-0800 TTYfMRS i-800-627-3529
f www.electricitv.srate.mn.us
Includes ihe Service arnVor Power Supply up ro 500 Amperes, NI
OF LESS THAN 50 VOLTS
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I Re1quesf1Da�e: Q/y�� Raugh-in Inspection Fequiretl? es ❑ No Inspection Otper Tnan Rough-In: ❑ Reatly Now W II Call
1{�( ?••^ �•j�:/� You mus[ call ihe inspector wM1en reatly! Oate ReaOy:
1 cerBty that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspedion of the elecirical work at:
Phone
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INSTqUC110NS ON BRCK OF YELLOW COP1