P - 83849RE(�UEST FOR ELECTRICAL INSPECTION
���= 7 41 Minnesota State Board of Electricity
J.� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Home Duplex Apt. Bldg. Ofher: New
Commercial Industrial Farm Remoc
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service �
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy
VdIRE GAI�AGE
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feed�
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100
Transformer/Generator INSPECTOR'S USE ONLY T�
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�_���'`��.
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Fee
i5.5o
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi Ifiaf I ins fed the elech'ical installafion deuribed herein on fhe dafes sfated
Irrigation Boom ' Rough-In ��� �_ �O� �d - 3, �7
Speciallnspectio �
Final /G. .:� ���%
Investigative Fee �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITFiIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monfhs from validafion dafe printed in this box.
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I IIII II ��I II III (I �II II III I) III III II (I� I I��I �.�"a��
* � 5 � 2 7 4 l+ �* RLEASE PRINT OR TYPE �Si �
Request Date Rough-in inspecfion required? ❑ Yes � No �nspecfion 01her Than Rough-In: ❑ Ready Now � Will Call
1�-1—�% (You musf call the inspector when ready) Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
lob Address (Sheet, Box, or Route No.) City Zip Code
6821 7TH STREET N.E. FRIDLEY
Section No. Township Name or No. Range No. Fire No. County
Occupanf
�308 JOHIVSON CONSTRUCTION
Power Suoolier Ac
Phone No.
Elechical Contracfor �Company Name) Conhacfor License No.
WEST STAR ELECTRIC, IIVC. CA01936
Mailing Address �Conhador or Owner Performing Insfallation�
6324 LAKE AVE N BROOKLYN PA12fC M1�T 55428
Au oriaeid Signature oMr cfor or Owner PerForming Insfallafio � Y`.}
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