P - 82542U=��34-759 �
itioner� ��}Jitg. Equip.
"X" above the work
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Avenue Suite S 128 Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us
Apt. Bldg. Other: X e�
4 —PLEX Ren
Farm
Wafer Htr. Loacl Mgmt. Other:
Elec. Heat Temp. Service
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this request. Enter remarks in �his space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Installations Fee # Service Entrance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall to 00 Amps 0 to 100 Amps
Street Lig. / Traffic Sig. Above 200 Amps �+(tbove' 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
85.50
$ign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi ihat I ins ected the electrical installation described herein on the dates state :
Irriqation Boom Rough-In � ` � Dare� /��p,�
Investigative Fee `"�`� �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WI��18 MONTHS.
OFFICE USE ONLY This request void 18 mont f ida}ion date printed in fhis box.
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PLEASE`PRINT OR TYPE
Request Date Rough-in inspection required? Yes ❑ No Inspecfion Ofher Than Rough-In: ❑ Ready Now � Will Call
6— 2 �— � � You must call the inspector when ready Date Ready:
I,�licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Roufe No.) City Zip Code
5603 4TH ST N.E. FRIDLEY
Sxfion No. Township Name or No. Range No. Fire No. County
Occupant Phone No.
P M J GROUP 651-704-3951
Power Supplier Address
Elechical Confracfor / Company Name Contracfor License No. Moster Lic. No. �Plant Elecf. Only�
EST STAR ELECTRIC, INC. CA01936
Mailing Address (Contractor, Company or Owner Performing Insfallation�
6324 LAKELA D AVE N BROOKLYIV PARK MN 55428
ized Si�Aature (Confra or Company or Owner Performing Insfallation� Phone Number
( �537-0807
EB-0 �5/1 9.' STAT RD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY