P - 79360REQUEST FOR ELECTRICAL INSPECTION
,1 213 618 Minnesota Board of Electricity
� � � 1021 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
�...
www.electraary.state.mn.us
I �NEW
❑REPAIR
50 VOLTS
over
ONE 8 TWO FAMILY DWtLLIN(i:
Includes �he Service anNor Power
Circuifs and Two Inwectlon 7rins
FOR OFFICE USE ONLY
I iI�II� ���II ����I III�I IIIII ��I�I I�I�� �II�I I�I�*1��
to 500 Amperes, All
:e is $20) �
pN.�
<—
�� � � y� SJ
ry es nougn+n ir�specuon Heqmre0� U ves �J No I Inspacpon Obiertban ROUgtrI¢ �peatly Now �J Will Call I
r� �' O� You must caN fie inspectrn when ready! Dale Reatly:
I cerey that I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby iequest inspectlon of ihe electncal work at
Job Atltlress BtreeL Box. ar Route No 1 . . Cirv �_ // . r� c,.ne
rkal (:ontrecto� 1 Company Name
Holmqoist Contrac[ing, Inc.
7056 Polazis Ln. No.
Maple Gmve, MN 55311
�nrzoao
PeNOmning
r.r3
BO�qD OF ElEC111iCT' COPY
B0.CK OF VELLOW COPV