P - 82362: � -o� 5-4s3 �
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REQUEST FOR ELECTRICAL INSPECTION -
Minnesota State Board of Electricity - `�
1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 -__ -
(651) 642-0800 www.electricity.state.mn.us :��i
Home Duplex Apt. Bldg. 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 ot the wnite copy onry.
N�P SAVER'S sWITCH
Calculate Inspection Fee - This Inspection Request will not be accepted without the
nstallations Fee # Service Entrance Size Fee # Circuits / Fee
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransformerlGenerator
Sign / Outline Ltg. Xfmr,
Alarm/Remote Control
Swimming Pooy � ; . �
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I herebvi certiN that I insoected the electrical
In
fee.
0 to 100 Amps
Above 100 Amps
TQIB�
a�
n described herein on the dates stated:
Date
Special Inspection
Investigative Fee �� � —6
THIS INSTALLATION MAY BE ORDERED DISC NNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� _.�._ .� ... •.._�.L•'L' •�.Y�L:'L:-ti4' ��L' • 'L��L"4 L' L' `�4'�+::�-3y5�-:G: '�:�L"...�.� ......................_...._ x _._ ..................................................................�
I II���� I�II� �I�II �IIII ��III I�� II�I� �� �� OFFICE USE ONLY This request vdd 18 months from validatbn date printed in this box.
* 1 0 1 5 4 9* �"�� ����
PLEASE PRINT OR E
Date - Rough-In inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now � Will Call
��� �� You must call the inspector when ready! Date Ready:
I, [�ficensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code:
756Q 4TH ST NE FRtDLEY 5643�2
Section No. Township Name or No. Range No. Fre No. Couw"���
t•���vrv�
�cU��` PiNEDA RE�GCA L Phone No.
Power�ppJj�r ( . r Address
5r +� !
Electrical Contractor / Company Name Contrador License No. Master Lic. No. (Plant Elect. Onty)
Hu� E�cntrc eoRPO�►-now cP► ao�
Mailing Address (Contractor, Company or Owner Performing Installation)
230d TERRITQI4IAL ROAD , SAINT PAUL, MM 56114
Authorize Signature Contractor, Company or Owner Performing Installation) Phone Number 4
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EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPV