P - 81215��4-285 �
REGIUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MfV 55104
Phone(612)642-0800
X Home Duplex Apt. Bldg. Other:
Commercia) Industrial Farm
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
g Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back
isolate dryer circuit
New
copy
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Calculate Inspection Fee - This Inspection Requesi will nof be accepted without fhe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator iNSaecroR'S USE ONLY TOTAL
Sign/Oudine Ltg. Xfmr. 20. 50
Alarm/Remote Control
Swimming Pool
I hereb cedi 1fiW I�ins ected 1Fie eleclrical inslallation described herein on lhe dates siated
Ifflqpti011 BOOfTI � Roualfln Date
THIS INSTALLATION MAY BE ORDERED OISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validation dafe printed in this box.
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PLEASE PRINT OR TYPE
Raquesf Dafe R h-in ins ey
Wg peclion r uired$ ❑ Yes [�No Inspecfion Ofher Than Ro�gMn: �Ready Now ��II Call
(You must call the inspeclor when ready� Date Ready:
I, $i�)icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Roufe No.) Cily Zip Code
4875 Third Street NE Fridley 55432
Section No. Township Name or No. Range No. Fire No. Couny
OccupoM Phone No.
Joe Erickson 571-7815
POW@f SUDDII@f . � � _.
Elecfrical Conhacfor (Company Name) Conhacfor License No. Master Lic. No. (Plant Elecl. Onl
Total Electric, Inc. CA02749
Mailing Address �Confracfor or Owner Performing Insfallafion)c� � .
107 Mankato Street, NE �G % ��1 Blaine MN 55449
Auth ignaNre (Conhacfor or Owner Perfor g Installafion) Phone No.
E A-118/96 �612� 786-8484
STATE BOARD COPY - SEE INSTRUCTIONS ON BsCK OF ve��ow rnav