P - 79341❑ REQUEST FOR ELECTRICAL INSPECTION
� r i��- 6 0 9 ,L Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 7TY/MRS 1-800-627-3529 www.electrictty.state.mn.us "
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Request Date: Rough-in Inspection Required7 Yes Inspedion Other Than Rough-In: ady Now � YYII Call
�$f2�� You must call tF�e inspector when ready! pete Ready:
1 certify that I am the [�Q.ICENSED CON7RACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Address (Street, Box. a Route No.) Zip Code
20 64TH WAY NE ~�'`-� FRiDLEY 55032
Sedion Township Range Fire No. County
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SM1TN RdBEF�T FRANK
XCEL ENERGY
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HUNT ELECTRIC CORPORATI4N CA 008$8
Mailing Address (Contractor, Company a Owner Performing InsfallaGon)
230Q TERRITORIAL R0,4D , SAIN7 PAUL, MN 55114
Authorized $ignature (CoMrada, Campany or O�mer Pe�fortning MstaNation)
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INSSRUCTONS ON BACK OF YELLOW COPY BOARD OF ELECTRICITV COPV
master tiecmaan or
Lioense Number
651 646-2911 �
EB-0OOO1M14 BA.2�02