P - 79998REQUEST FOR ELECTRICALINSPECTION
Minnesota Board of Electriciry
1-381-465 � 1821 University Avenue Suite 5-728, Saint PaW, Minnesota 55104
(651) 642-0800 TTYIMRS 1�800-627-3529
www. elecfricity. s fa fe. mn. us
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FOF OFFlCE I/SE ONLY
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lequest Da�e: Rough-in Inspection qequiretlP ❑ Ves ❑ N�nspe�no0� r Than Rough-in; 0 Rea�w p Will Call
nor�am�
-�- -- rou must calllhe inspeclorwben ready! �a�e Reatly:
I cerlify that I am fhe LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspedion of the electrical work at:
Job Adtlress (Street, Box, or Route No.) City � Zip Cotle
8418 RIVERVIEW 7ER NE FRIDLEY 55432
IS r_nn ge Fire No. County
I�w��" I�"° I I A�A
ENGLUNG OORCKJN R
Pawer Sopplier Adtlress i '
XCEL ENERGY '� ��� J fj
I eiepncai Wmrecbr / Compsny Name Contracmr
n��� � ��c� i rc�� 4UKNVKA I IUN I CA 00883
ldtlress (Cqrryrac[oq Compsny ar Owner Pertorming Installation)
2'�UD TERRITORIAL ROAQ , SAINT PAUL, MN 55114
80ARD OF ELECTqICITV COPV INSTRUCTIONS ON BACK OF