P - 79214REQUEST FOR ELECTRICAL INSPECTION �
��(��- 5 3 6� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
' (651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
� �� � R 4 � g.9
� i�ii ii � ii ii{ {�-�i ii i�i ii iii � ii{ ii iai � �ii i�
17685363 �/
�C�`Z - C%l ���35� �SO
st Date: Roughin Inspection Required? ❑ Yes 0'No Inspection Other Than Rough-In: ❑R�ady Now ❑ V1hll Call
07��� You must call the inspeclar when ready! Date Ready:
I certify that I am ihe �ICENSED CONTRACTOR ❑COMPANY p OWNER and hereby request inspection of tlie electrical rro�c at::
Job Site Address (Street, Box, or Route No.) City Zip Code
S?7 FiICE CREEK TER NE FRIDLEY 55432
Section Tarxnstrp RangE1 � Fire No. Cou�ry %wOtil11
CJ �
� �
Owner/Oaupant Name Please Pro�ride Two (2) Phone Number(s) Indudi� Area Code
�3UEHN R!C!�lP,RD KE{TH ( � ( )
Power Supplier Power SupPlier Address
XCEL ENERGY
Contracta! Canparry Name ConVactar License Number Master Electridan a Power Llmited Technician
iiUNT ELECTRIG CORPORAIICUN CA 00868 License Number
Maiiing Address (Contradw, Company or Owner PerForming Installation)
2300 TERRITORL4L R�AD , SAINT PAUt, MN 55114
Autharized Si9naWre (CoMracta� ComPeny a OMmer Performing I�tallffiion) Phone (s)
�?r(�uft �leo�a�r.r B�1 sas-aai i
INSTRUCTONS ON BAGK OF YELLOYV COPY BOARD OF ELECIRICITV COPV EB-OOOD1A-74 8.1. 2002