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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electriciry
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 '��
Other: New Addn
Industrial farm Remod
Htg. Equip. Water Htr. Load Mgmt. Other:
Range Elec. Heat Temp. Service
overed by this request. Enter remarks in this space and on the back of the white copy only.
BATHROOM REMODEL
Calculate Inspection Fee - This Inspection Request will noi be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps to 100 Amps
Street Lig./Traffic Sig. Above 200 Amps Above 100 Am
Transformer/Generator INSPECTOR•s use oN�v TOTA
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Fee
30.50
I hereb certi that I ins ted the elecfrical ins�allafion described herein on the dates stated
Irrigation Boom Rough-In > Date
Special Inspecti , � Z
Final ,�
Imestigative Fee � �
THIS INSTALLATION MAY BE ORDERED DISCO CTED IF NOT COMPLETED W HIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validation date prinfed in this box.
I II�I II III I) III II III II III I) II I III II III I(II) ��a � 9
* 0 5 5 3 9 2 9 ]� �K PLEASE PRINT OR TYPE v�' ��
Requesf Dafe Rough-in inspecKon required? �Yes
❑ No Inspection Other Than Rough-In: ❑ Ready Now � Will Call
1 1— 2 �— 9 (You must call the inspecror when ready� Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sheet, Box, or Route No.� City Zip Code
7340 EAST RIVER RD FRIDLEY
Section No. Township Name or No. Range No. Fire No. County
OccupaM � I Phone No.
ED' S HOME IMPJ20VEMENT
Power Suoolier Add.>«
E�ectrical Conhacfor (Company Name)
WEST STAR ELECTRIC
Mailing Address (Confracfor or Owner Performing In.
6324 LAKE ANt� AVE
Au rized Sipnature o acfor or Owner Performir
Lic.
� CA01936 �
allation)
d BROOKLYN PARKMN 55428
� Installation) � Phone No.
25� r� 537-0807
COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY