P - 82156REQUEST FOR ELECTRICAL INSPECTION �o°'E
U-�� J- 6 7 3�I Minnesota State Board of Electricity �'
1821 University Avenue Suite 5-12$ Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us `���
Home Duplex Apf. Bldg. Other: New Addn
Commercial Indusfrial Farm x Remod Repair
Air Conditioner Hig. Equip. Wafer Htr. load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without ►he correct fee:
Other Installations Fee # Service Enfrance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 30/� O 0 to 100 Amps p,;�
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign / Outline Ltg. Xfmr. �� �
Alarm/Remote Control ��
Swimming Pool ^ g��J�
I hereb certi that I ins cted the elechical insfallation described herein on fhe dates stated:
Irriaation Boom_ o_.._� �_ _ .. . _
�� Investigative Fee � ��'�� �� �� I'"�� 3��U I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 months from validation date printed in Ihis box.
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PLEASE PRINT OR TYPE
Requesf Date Rou h-in ins ection r uired? es
g p eq ' ❑ No Inspection Other Than Rough-In: ❑ Ready Now � Will Call
S— 1 7— O O - You musf call the inspector when ready Dafe Ready:
I„� licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Skeet, Box, or Roufe No.) � City Zip Code
1090 52nd Ave. �P7' ,�.ot� Fridley
Secfion No. Township Name or No. Range No. Fire No. County
Hennepin
Occupant K J M a n a g e m e n t Phone No.
Power Supplier Address
NSP 3115 Center Point Dr. Roseivlle
Electrical Conhacfor / Company Name Contractor License No. Master Lic. No. (Plant Elecl. Only�
� Bassing Electric, Inc. Ca00237
Mailing Address (Confractor, Company or Owner Performing Insfallation�
1354 McKay Drive NE, Ham Lake, MN 55304
Authorized ' nature (Conh�� ny or Owner Per�rm� InOstallation) Phone Number
� � 1 8 (76�-434-3298
EB-00001A-12 5/1999 ST BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY