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REQUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Electricity '.3
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 `'�`
Other: New Addn
Farm
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
this request. Enter remarks in this space and on
BATHROOM REMODEL
copy
Calculate Inspec►ion Fee - This Inspection Requesi will not be accepted wiihout the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL 3 0. 5 �
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool ��r certi that I ins the electrical installation described herein on the dates rated
Irrigation Boom RougMn
Special Inspectio
Final .
Investigative Fee �
THIS INSTALLATION MAY 8E ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE U8E ONLY This requesT void 18 months Srom volidotion dote printed in this box.
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PLEASE PRINT OR TYPE
Request Dafe Rough-in inspecfion required$ � Yes ❑ No Inspecfion Ofher Than RougMn: ❑ Ready Now 0 Will Call
1 21 —19 — 9 8 �ou must call tha inspector when ready) Date Ready:
I, �'icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sireet, Box, or Route No.) Ciy Zip Code
FRIDLEY
74
Section No. Township Name or No. Range No. Fire No. County
Occupanf I Phone No.
PLUMBLINE BUILDERS. CONTRACTOR
Elechical Conhactor (Company Name) Conkactor License No. Masfer Lic. No.
WEST STAR ELECTRIC, INC. CA01936
Mailing Addreu (Conhacror or Owner Performing Installafion)
i324 LAKELI�ND AVE N BROOKLYN PARK MN 55428
A
Aufhorized S�qnafure (C _ r or Owner Performing Insipllafion) � Phone No.
� v � � �- � 537-080�
BOARD COPY - SEE INSTFtUCiIONS ON BACK OF YELLOW COPY