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REQUEST FOR ELECTRICAL INSPECTION �
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Minnesota State Board of Electricity �'���
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 �-� �
(651) 642-0800 www.electricity.state.mn.us
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Commercial Industrial Farm
�Air Cond't er tg. Equip. Water Htr. Load Mgmt. Other:
rye J g Elec. Heat Temp. Service
"X" ove the work covered by this request. Enter remarks in this space and on the back of the white copy only.
2816U
Calculate Inspection Fee - This Inspection Request will noi be accepted without the correct fee:
Other Installations Fee # Service Entrance Size'' Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0"Amps � 0 to 100 Amps
Above 2 0 Am s Above 100 Amps
Street Ltg. / Traffic Sig. P TOTAL
Transformer/Generator INSPECTOR'S USE ONLY $ r., , c� �
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool I hereb cerfi fhat I ins ected the elecfrical installation described herein on fhe dafes sfated:
Irrigation Boom Rough-In � e �----d�
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Special Inspection Final � r Z Q— Ocl
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validafion dafe prinfed in }his box.
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PLEASE PRI�@��ll�V
Re uest Dafe Rough-in inspection required? � Yes ❑ No Inspecfion Other Than Rough-In: ❑ Ready Now 0 Will Call
�—� O— O O You must call the inspector when ready Date Ready:
1, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
1ob Address (Street, Box, or Route No.� City Zip Code
5605 4TH ST N.E. FRIDLEY
Section No. Township Name or No. Range No. Fire No. Counfy
Occupanf Phone No.
P M J GROUP 651-704-3951
Power Supplier Address
N S P
Elecfrical Confractor / Company Name Contracior �icense No. Master Lic. No. �Plant Elecf. Only)
WEST STAR ELECTRIC, INC. CA01936
Mailing Address (Contractor, Company or Owner Performing Insfallation�
6324 LAKELA VE N BROOKLYN PARK MN 55428
Aufho ' Signat re(Con}ract , omp ny or Owner Perform' g Insfallafion� Phone Number
( � 537-0807
EB-� ATE BOAR OPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY