P - 80549- REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electriciry
� 1-379-981 � 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-600-627-3529
www.electnciry.sfate.mn. us
FOfl OPPICE USE ONLY
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� 29023
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08/10/01 Vou must call Uie inspec�or when reatly� oat a d
r
I certify that I am ihe LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electncal work at:
Job Adtlress (Streeq Box, or Rome NoJ Ciry Zip Cotle
t481 WINDEMERE CIR NE FRIDLEY 55421
Section Tawnship Range Fire No. pp�p�y �
aNOKa
Oxupam Phone
HpRMON RO E T
Power Svpplier Adtlress
I Company
Company or
License Number � Master Gcense
Compeny or Owner Performing Installa�ion) � Phone
BOARD OF ELECTRICIN COPY INSTqtlC710N5 ON BACK OF YELLOW