P - 80199REQUEST FQR ELECTRICAL INSPECTION
.Z _ O ^ ^. � H � _. Minnesota Board of Electricity " .$
:1 t5 1821 University Avenue Suite S-728, Saint Paul, Minnesota 55104
= �� �ssi� saz-oeoo mmnRS i-eoasz�-aszs � �S. `
;...♦,
www.etectnary.siate. mn. us .
Identiry ihe work covereA by this request: / - J _'!6j- S�Z ' I YY�o'
/�",/, �u,�,I /�b�vn �^
❑NEW ❑FEMO�EL ❑ADDITION'ffiflEPAIR ' � � � %
ONE 8 TWO FAMILY DWELLINGS, EAGH UMf
Includes ihe Service anNor Pvwer Suppry up [0 500 Amperes, NI
Circuits and Two Inspection TriOS Each �welling Unit �$B(
FOR OFFICE USE ONLY
I{IIII1111111fllfllllllffll{{if11111lIIII1811111 . �,,,�;;�t��� ._,�a,so
I I ��� ��� 0� I Vou muat call ihe inapec[or when reatly! I Oate Reetly. � I
I I ceriity thai 1 am ihe [�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby requesf inspecfion of the elecMcal work at:
Job HOtlress (Street, Bo%, w Route Nj
� 53�s
Seclion Township
Occup&�1
& �6
Power Suppliar
�� L �
Eleciri�al Convactor / Company Name
EB�OOOOiN�13 ]/t200U
No.
zol {y
..��
o,�w,�� ����zl mw ��3�
iflny o� Owner PaAO�ming Mstailali PMne
7(a3—�
r' BOMO oF ELELm�cm GOVr IN6raUC1
70`�'C' �
J�CK OF YELLOW COPY