P - 82545REQUEST FOR ELECTRICAL INSPECTION
r, ^.�, � �7 �� � Minnesota State Board of Electricity
U�`�' �j r � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us "�'
X Home Duplex Apt. Bldg. Other: New Addn
�� 4—PLEX Remod Repair
�ommercial Industrial Farm
oqditioner tg. Equip�, Water Htc Load Mgmt. Other.
Drye ange / Elec. Heat Temp. Service
"X" a ove the work covered by this request. Enter remarks in this space and on the back of the white copy only.
j
2810�
Calculate Inspection Fee - This Inspection Request will nof be accepted without the correct fee:
Other Installations Fee # Service Entrance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 00 Amps �, 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
85.50
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ected the electrical insfallafion described herein on ihe dates stated:
Irrigation Boom Rough-In Date ��e
Special Inspection p e
Final ., r Q ,_ �a
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS'
--� ----------_. ------- --
OFFICE USE ONLV This request void 18 months from validation date printed in fhis box.
I IIII II III II IiI II III II III II III II�IM�Nllll lll illll t��s��
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PLEASE PR��
Request Date Rough-in inspection required? � Yes ❑ No Inspection Ofher Than Rough-In: ❑ Ready Now ❑ Will Call
6— 2 �— Q � You must call the inspector when ready Date Ready: -
1, �icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
�$g�X��K 5607 4TH ST N.E. FRIDLEY
Secfion No. Township Name or No. Range No. Fire No. County
Occupanf
P M J GORUP
Power Supplier Addres
N S P
Electrical Contrador / Company Name
WEST STAR ELECTRIC, INC.
Mailing Address �Contractor, Company or Owner Performing install�
Phone No.
651-704-3951
�ctor License No. I Masfer Lic. No.
CA01936
6324 LAKELA D AVE N BROOKLYN PARK MN 55428
Auf rize Sign\jture �Contrado ,-Co pany or Owner Performing Installation� Phone Number
( ) 537-0807
=B-00001 . 1 STATE RD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY