P - 822540
1,015-273 04 REQUEST FOR ELECTRICAL INSPECTION '`�E`•
Minnesota State Board of Electricity F:-
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 - _
(651) 642-0800 www.electricity.state.mn.us '.- '
Home Duplex Apt. Bidg. Other: New Addn
Commercial Intlustrial 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.
NSP SAYER'S SWITCH
Ca/cu/ate Inspection Fee - This Inspection Request will not be accepted without the correct fee.
nstallations Fee # Service Entrance Size Fee # Circuits / Feeders
Mobile Home Park Stail
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
1 hereby certity that I inspected the �
Rough In
0 to 100 Amps
Above 100 Amps
TQ�/;1�„�
ou au
installallon described herein on the date
Date
rma �/� �,. I uace,., � ���
Investigative Fee ��� � 2 J
THIS INSTALIATION MAY BE ORDERE ONNECTED IF NOT COMPLHTED WITHIN 18 MONTHS.
............._.................................................................. . ...... .�....... . .
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( IIIIII IIII) IIIII IIIII IIIII (I I III� ��I OFF�E USE ONLY This requeet vaid 18 �nths f�om validation date printed in this box.
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PLEASE PRINT OR E
Request Date Rough-In inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
J� 1��fyyy You must call the inspector when ready! Date Ready:
I, [�ticensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address Street, 41'H ST N� c�RfDtEY �p C�
Section No. Township Name a No. Range No. Fre No. Coun�ty�qy�
� ' /'tlW�V'l
Occupant �EY CHRISTINE T Ph°°e "°.
Power �pp�r � � Address
5
Electrical Co�tractor / Company Name Contractor License No. Master Lic. No. (Plant Elect. Only)
HUNT ELECTRIC CORP4RATiON CA 00883
Mailing Address (Contractor, Company or Owner Performing Installation)
23�d TERRITORIAL RO,AD , SAINT PAUL, MN 5l�i i 4
Authorize Signature Contractor, Company or Owner Performing Installation) Phone Number
� � �� �� 1
EB-OOOOtA-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY