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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55iO4
Phone (612) 642-0800 `'°�'
Apt. Bldg. Other: New Addn
Farm Remod Re air
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this space and on the back of the white copy only.
reconnect furnace
Calculate Inspection Fee - This Inspection Request will noi be accepted wi►hout the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT�L O. 50
Sign/Outline Ltg. Xfmr. L
Alarm/Remote Control
Swimming Pool [�
I here certi � 1�s � the electrical installafion described herein on the dates sfated
Irrigation Boom RooyM„ �re
Special Inspection
Final D
Investigative Fee ' C �
THIS INSTALLATION MAY BE ORDERED DISCON CTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFPICE USE ONLY This request v�id 18 months from wlidation date printed in this box.
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PLEASE PRINT OR TYPE
Requesf Date Rough-in inspeclion required2 ❑ Yes � No Inspection Ofher Than Rou h-In: �Ready Now � Will Call
0 9- 2 4� � 1 �You musf call fhe inspecfor when ready� oa� R�dY: 0 9-�l 4- O 1
I, �] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Roufe No.) Ci1y Zip Code
6001 4th St. NE Fridley 55432
Secfion No. Township Name or No. Range No. Fire No. County
Occupant
Phone No.
Sally Schmidt (763)571-8198
upplier d
xcel energy '`�
I Contracror (Company Name) Contracror License No. Master Uc. No. (Plant Elecl. Only)
Brandon Electric Inc. CA00307
Address �Conhacror or Owner Pe�forming InslallaKon)
7701 olfax Ave. N. Brooklyn Park, MN 55444
ed Si atur (C nhactor or Owner Performing Install,Kon� Phone No.
(763)560-5311
1 A-1 1 8/96 STATE BOARD COPY - SEE INSTlIUCTIONS ON BACK OF YELLOW COPY