P - 82084E
� REQUEST FOR ELECTRICAL INSPECTION
�J-gSg_Q � 1 � Minnesota State Board of Electricity `�
V 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
�� (651) 642-0800 www.electricity.sfate.mn.us :- -'
X Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
x" above tne work covered by this request Enter remarks in this space and on the back of the white copy on/y.
N3P SAVER'S SWITCH
Calcu/ate Inspection Fee - This Inspection Request will not be
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irrigation Boom
Sp2C111 I�SD@Ctl / .,
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
Rough In
that I
without the correct fee.
Circuits / Feeders Fee
0 to 100 Amps
Above 100 Amps
TOTA�
installation described herein on the dates stated:
Date
�stigative Fee � � �..���, � �� �p--v-a
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
III �IIII ���� �IIII IIIII IIII�II� Illf �I
*08598112*
OFFlCE USE ONLY This request void 18 months from validation date printed in this box.
� a0 -�
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PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes ❑ IiD Inspection Other Than Rough-In: LJReady Now ❑ Will Call
{I�I�4IOO You must call the inspector when ready! Date Ready:
I, �] licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Z�P C��
8455 21i2 ST NE FRfCN.EY 55433
Sedion No. Township Name or No. � Range No. Fire No. County .
'°°°°° �__-- '____. �_.��°° �
Occupant Phone No.
BERG KIMBERLY KAY -----
Power�sP r � }y � ,,,, Address --...N.�
t 4 r�
Electrical Contractor / Company Name Contrector License No. Master Lic. No. (Plant Elect. Onty)
HUIdT ELEGTRI� CGRPORATIQN CA 40883
Mailing Address (Contractor, Company or Owner Pertortning Installation)
2300 TERRtTC)RIAL ROAD , SAINT PAUL, MN 55114
Authorized Signature (Contractor, Company or Owner Performing InsTallation) Phone Number
�
EB-00001A-72 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY