P - 78661REQUEST FOR ELECTRICAL INSPECTION
1� 412 ��^� o� Minnesota Board of Electriciry
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(6511642-0800 TTY/MRS 1-800�27-3529 www.electriciry.state.mn.us
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Requesl Date: Roughin Inspection Required? es ❑ No inspedion Other Tha� RougMn: �Ready Now ❑ WNI CaA
^� � �.; You must call fhe inspedor wfien readyl Date Ready. ,
I cerMy that I am 1he�tTCENSED CONTRACTOR � COMPANY ❑ OWNER and heieby request inspection of the electrical work at:
` Zip Code
Job Site Address (Sbeel Box a Route No.) ;_fp�r
1136 NORTON AVE NE FRIDLEY
PMJ HOMES � ~ v � � I � � � �
itrada / Company Neme � Contractor License NumDer Master F1ecv�Gan or Yower um�a i ecnmu�
WEST STAR ELECTRIC� INC. CA01936 LicenseNumber
iling Address (Contractor, CompanY or Owner PerFortning InstaAation)
� 6324 LAK LAND AVE N BROOI�LYN APRK MN 55428
�' Signaffire (Contrado pany or Owner Perfaming I�stallation) Phone (s)
763 537-080
�TR ON BACK OF COPY BOARD OF ELECTRICITV CAPV E8�00001M11 B.t. 2002