P - 82049REQUEST FOR ELECTRICAL INSPECTION �
fl �� i A� Q Q� � Minnesota State Board of Electricity
l•� ��+ V�� 1821 University Avenue Suite 5-12$ Saint Paul, Minnesota 55104-2993
' (651) 642-0800 www.e%ctricity.state.mn.us `m��
Home }{ Duplex Apt. Bldg. Other: New Addn
Commercial Indusirial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. $ervice i
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
WIRE GARAGE
Calculaie Inspection Fee - This, Inspection Request will not be accepted without the correc► fee:
Other Installations Fee # Service Enhance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign / Outline Ltg. Xfmr. 20 . 50
Alarm/Remote Control
Swimming I
I hereb certi that I ins ted the elechical installafion described herein on the dates stated:
Irrigation Boom Rough-in Dare
Special Inspection
Investigative Fee F���� ���cS" ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This r��esf void 18 months from validation date printed in this box.
��I�N�I��N��N��I����i��1������ � a6 5a
* 0 8 7 4 8 9 7 Z* O?� /�
PLEASE PRINT OR TYPE
Request Date Rou h-in ins ection re uired2 ❑ Yes
g p q � No Inspection Other Than Roughan: ❑ Ready Now � Will Call
4- 3- 0 0 You must coll the inspector whan ready Date Ready:
I, � licensed contractor ❑ company ❑ owne� hereby request inspection of the above electrical work at:
Job Address �Sireet, Box, or Route No.) � Ciy Zip Code
5622 4TH STREET N.E. FRIDLEY
Secfion No. Township Name or Na � Range No. Fire No. County
Occupanf Phone No.
Power Supplier � ��� � �i'iddreu �
Eledrical Conhactor / Company IJame Contractor License No. Masfer Lic. No. (Planf Elect. Only�
WEST STAR ELECTRIC INC. CA01936
Mailing Address (Confractor, Compony or Owner Performing Installa}ion)
6324 ALKELAND N BROOKLYN PARK MN 55428
Auth ize ' nalur� (Contractor, Com ny r Owner Performing Installation) Phone Number
� �537-0807
E&0000 - 99 BOARD SEE INSTRUCTIONS ON BACK OF YELLOW COPY