P - 80351REQUEST FOR ELECTRICAL INSPECTION
�/ %C Minnesota State Board of Electricity �
I' � 1—� 1�7 � 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 '� '
Home Duplex Apt. Bldg. Other: �""� New Addn
Commercial Industrial farm , Sd �/G(;f-rfl�� Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
„X„ above the work covered by ►his request. Enter remarks in this space and on the back of the white copy only.
changing 1-100A Singla Phase Over
Head Service
Calculoie Inspeciion Fee - This Inspection Request will not be accepted without the correct fee: a ff(S
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stoll 0 to 200 Amps 7 0 to 100 Amps
$treet Ltg./TraFfic Sig. Above 200 Am s �• Above 100 Amps
Transformer/Generafor INSPECTOR'S USE ONLY TO A`�
Sign/Outline Ltg. Xfmr.
Alarm/Remote Confrol �a,
Swimming Pool
I}�ere "terti ihat I ins ected the electrical installafion dexribed herein on the dates stated
�ffl9q}IOfI B .Roughan -� Dafe
Sp2CIO� �I15 I ,
Pinal � Date
Investigative Fee j.--dr>
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED W HIN 18 MQNTHS�_
OFFICE USE ONLY This request void 18 months kom validation dafe printed in this box.
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* 0 7 1 7 3? 5 0* (�`�
PLEASE PRINT OR TYPE
Requesi Dafe Rough-in inspection required2 ❑ Yes �lo Inspeclion Other Than RougMn: � Ready Now � Will Call
0 3-16 - 0 0 �You must call fhe inspector when ready) � R�,.: 0 3-16 - 0 0
I, [� licensed contractor ❑ owner hereby request inspection of the obove electrical work at:
Job Address (Sheet, Box, or Route No.) Ciy Zip Code
125 49th Ave. Fridley 55432
Section No. Township Name w No. Range No. Fire No. Counly
� v �� �O�zA
p���pa�� Phone No.
Chau Van Nguyen (763)572-3778
Power Supplier Address
NSP � D�'� /!/l.�lD�II
Electricol Contratlor (Company Name) Conhacror License No. Moster Lic. No. (Plant Elect. Only�
Brandon Electric, Inc. CA00307
Mailing Address (Conhacfor or Owner PerForming InsMllafion� �
7701 Colfax Ave. N. Brooklyn Park, MN 55444
Au Signafure (Confracfor or Owner Performing Insfall '! . Phone No.
' � �`# (763)560-5311
E&00001 A-11 8/96 y7p7� BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY