P - 82253� -� 15-272
t.
� REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity _
1821 University Avenue Suite 5-128, Saint Paol, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us :- '
Home Duplex Apt. Bldg. Other: New Adtln
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
'X" above the work covered by this request. Enter remarks in this space and on the back of the white copy on/y.
W5P SAVER'S SWITCH
Ca/culate Inspection Fee - This Inspection Request will not be accepted without the
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
0 to 100 Amps
Above 100 Amps
TOTAL
�.�
I hereb certiTy that I ins ected the electrical installation described herein on tlie dates stated:
Irrigation Boom Rough In Date
Special Inspe
Investigative Fee Final oat � � � ���
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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OFflCE USE ONLY This request vdd 18 ma�ths.from validalion date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: Ready Now � Will Call
�'� 4�`� You must call the inspector when ready! Date Ready:
I, [�icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, BOx, or Route No.) City ZP Code:
57&0 212 ST NE FRtDtEY 5643�
Section No. Township Name or No. Range No. Fre No. Coun�ry�y�
• /'Y�V�/1
Occupant Phone No.
AUMOCK BRENdA K
Power Su lier � Address
2Y �
Electrical Contractor / Company Name Contractor License No. Master Lic. No. (Plant Elec[. Onty)
HUA1T ELECTRI� CORRORATICiN CA Q09�i
Mailing Address (Contractor, Company or Owner Performing Installatlon)
230Q TERRITORU�L ROeAD , SAINT PAUL, MN 66i 1+1
Authorize Signature •SContractor, Company or Owner Performing Installation) Phone NumQbe�r
,� � ( �� fI'l�T�1 �
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY