P - 79393REQUEST FOR ELECTRICAL INSPECTION
�� � � � � � _ Minnesota Board of Electricity �'
� � 1821 Univereiry Avenue Suite 5-128, Sainl Paul, Minnesota 55104 �
a'p (651)642-0800 TTY/MRS1-SOd627-3529
CCITY www.eiectricity.statemn.us �'
Itlenifi/ttieworkcoveretlbythisrequest ° T_L'�I D M,j�GE—IN � ALL NEYJ M•A$T.
❑NEW ❑REMODEL ❑ADDITION �REPAIR ZOOA MF,TEP.� NE4v �.00�1 CONDUCTORS.
� ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Inclutles ihe SeNice anNor Power Suppy up to 500 Amperes, All
r. Circimc and Twn Insnectbn Tnos Each �wellino Uni� �$BC
CIRCUITS OF
� FOfl OFFICE USE ONLV
i*IIIII Eilli II fI IIIIIIIIII IIIII IIIII IIIII iIII IIII
total fee is
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I nequest ua[e: �HOUgM1tin inspacGOn Hequlretl4 �J Ves � No I InspectioMONkr Eh�l R�itA: ❑ ReaRy Now �Will Call I
1 Q f 2 Z�{� 2 You must call 9re inspector when ready! Date Feady:
I certlty ihat I am lhe �] LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe elecirical urotk at:
Job Adtlress (S�reet, Boz, or Route No.) Ciry Zip Cotle
6736 — 7TH ST. NE FRIDLEY 55432
Seqion Tawnship �e � Fire No. County
� �� ANOKA
occupant phone
XCEL ENERGY 1518 CHESTNUT AVE. MPLS, MN 55403
raclor l Company Name Contrxmr License Numbei Master Lianse Number
�QUSKA ELEC. C0. CA012$7
�s (COntrecloq Company or Owner Pedorming Insfalla[ion)
�985 OAKCREST Ij37,E. ROS�VILLE, MN 55113
�
nirz000
BppHD OF
—'036-5820 �
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