P - 83170REClUEST FOR ELECTRICAL INSPECTION
613 �� 2 4� 8f21 Uni eSsity A earRm. S-128,'St. Paul, MN 55104 �`
� Phone (612) 642-0800 '��
X Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Y: Temp. Service
"X" above the work covered by this request. Enler remarks in this space and on the back of the white copy only.
ADDN/REMODEL GARAGE & FAMILY ROOM NEW SERVICE
Calculate Inspection Fee - This Inspecfion Request will not be accepted without the correct fee:
Other Fee # Se ' E rance S' e Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 t 200 mps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL 3 O��
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
�hereb certi tlwt 1 ins the eleclrical installation deuribed herein on the dates stated
Irrigation Boom RougMn Da �—
Special Inspectio �
Final D
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONT S.
OFFICE USE ONLY This roquest void 18 months from validation date printed in this box.
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* 0 6 1 3 8 2 4 2* 0731�
PLEASE PRINlT OR TYPE
R uest Date Rou h-in ins on r uired$ Yes
�_ 5_ 9$ g pecti eq ❑ No Inspecfion Other Than RougMn: ❑ Ready Now 0 Will Call
(You must call the inspector when ready) Date Ready:
I, [�licensed contractor ❑ owner hereby requesF inspection oF the above electrical work at:
Job Address �Sheet, Box, or Route No.� Ci1y Zip Code
117 alden circle FRIDLEY
Secfion No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
p4�II�TYX����ZR MONTY GUNIA
Power Supplier Addrass
N S P
Electrical Contmcror (Company Name) Conhacror License No. Master Lic. No. �Plant Elecl. OnlyJ
WEST STAR ELECTRIC, INC. CA01936
Mailing Addreu (Conhacbr or Owner PerForming InstollaHon� �
6324 LAKELAND E N BROOKLYN PARK MN 55428
Aufhori Signatuc� (Conhacfor or r erforming Insfallafion) � Phone No.
,2 C3 V' ; ; 537-0807
EB-0000 -11 /96 STATE BO COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY