P - 82544REQUEST FOR ELECTRICAL INSPECTION �v�'
7 ^}( s° Minnesota State Board of Electricity �' ;
U Q 3 �f � 1� V � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us "�'
!'n1���LY�P InCnA!'fl!]II FAP. - Th15 Insoection Reauest will not be accepted withouf th �o� �ee:
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETEU w� � nirv � u mvrv � na.
OFFICE USE ONLY This request void 1 8 months from validation d fe printed in fhis box.
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PLEASE PRMT`0��
Request Date Rough-in inspection required? Yes ❑ No Inspecfion Ofher Than Rough-In: ❑ Ready Now ❑ Will Call
6— 2 �—_ � � You musf call ihe inspecfor when ready Dafe Ready:
1, � licensed contractor ❑ company ❑ owner
Job Address (Sfreef, Box, or Route No.)
5601 4TH ST N.E.
Secfion No. Township Name or No. Range
hereby request inspection of the above electrical work at:
C�h, Zip Code
FRIDLEY
o. Fire No. County
Occupanf Phone No.
P M J GROUP ��� 651-704-3951
Power Supplier Address
N S P
Eledrical Contractor / Company Name Contractor License No. Master li
WEST STAR ELECTRIC, INC. CA01936
Mailing Addreu (Confracror, Company or Owner Performing Installation�
6324 LAKELA� AVE N BROOKLYN PARK MN 55428
oriz SigTNure �Contractor, o any or Owner Perfoiming Insfallation� Phone N
STATE BqlCRD COPY
Elecf.
I( )537-0807 �
SEE INSTRUCTIONS ON BACK OF YELLOW COPY