P - 84459REQUEST FOR ELECTRICAL INSPECTION -��..
/) O��� � O(� Minnesota State Board of Electricity
`f , � J 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-OS00
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re ir
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. $ervice
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance i e Fee # Circuits/Feeders Fee
Mobile Home Park Stall 1 0 to 00 Amps 1 0 to 100 Amps
$treet Ltg./Traffic $ig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. �, `•« ; — 75. 50
Alarm/Remote Control ,_Y;yr,,�„� �K� - C� c7!c�c. �
Swimming Pool
I hereb certi that I ins ted fhe elechical installafion described herein on the dates stafed
Irrigation Boo N Rough-In Date
Speciallnspe x
Final �" � / J�—_ �
Investigative Fee `_��r.
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
�� OFFICE USE ONLY This request void 18 monfhs 6om validation date printed in this box.
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* � 4 � 5 2 8 9 �* PLEASE PRINT OR TYPE
Request Dafe Rough-in inspecfion required? ❑ Yes [�Jo Inspection Other Than RougMn: ❑ Read Now
y �] Will Coll
3/ 11 / 9 7 (You must call fhe inspecfor when ready) Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:"
Job Address (Sheef, Box, or Route No.) City Zip Code
4538 3rd St NE Fridley 55432
Secfion No. Township Name or No. Range No. Fire No. County
Anoka
Occupant
Phone No.
Friis, Ella 572-1531
Power Supplier Address
NSP North Division 3115 Centre Point Dr, Roseville MN 55113
Elechical Contracfor �Company Name) Coniractor License No. MasFer Lic. No. �Plant Elect. Only�
Total Electric Inc CA02749
Mailing Address (Conhactor or Owner Pe,forming Installation)
1537 92nd Ln NE Blair_e MN 55449
Authoriz ignature (Conhactor or Ow Performing Insfall ion) .. ,�� . Phone No.
�..�/ � � � ' � 786-8484
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8-0000 A-1 1 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY