P - 81156REQUEST FOR ELECTRICAL INSPECTION �` F
O,� .%�'�Q� � Minnesota State Board of Electricity - _
V 1821 University Avenue Suite S-128, Saint Paul, MinnesoW 55104-2993
(651) 64.2-0800 www.e/ectricity.state.mn.us r "
Home Duplex Apt. Bldg. Other; New Addn
Commercial Intlustrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Loatl Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
JC" above the work covered by this request. Enter remarks in this space and on the back of the white copy on/y.
N3P 3AVER'3 3WlTCH '
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimmin� Pool
Fee - This lnspection Reouest wi!! not be accevted without the correct fee.
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
Rough In
Special Insped�n (
Fi
Investigative Fee
THIS INSTALLATION MAY BE
illill IIIII IIIII Illii IIlil I�III�Y`IIIiI �I �!
*os5s2sss*
0 to 100 Ai
Above 100
TO
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described herein on the tlates stated:
Date
I �,�n� � �/
ED DISCONNECTED IF NOT COMPLETED WITHIN S�
�FICE USE ONLV This request vdd 18 months from validation date printed in this box.
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76s�
PLEASE PRINT OR
Requesl Date Rough-In inspection requiredl � Yes � No Inspedion Other Than Rough-In: � Ready Now ❑ Will Call
11/1� You must call the inspector when ready! Date Ready:
I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Addre�aat, BoX, o�� A.V€ NE c�� FRfDLEY zp 564Z1
Section No. Township Name or No. Range No. Fire No. Cou�ry �,�,�a
Occupant hR�B�� �N � Pho�e No. N�
V
Power Supplier Address _��
I�P
Electrical Contraclor / Company Name Contractw License No. Master Lic. No. (Plant Elect. Only)
HUNT ELECTRi� CC�RPORATiON CA 00�83
Mailing Address (Contractor, Company or Owner Performing Installation)
23Q0 TERRIT+�RIAI RQAD , SAINT PAUL, MN �114
Authorized Signature (Contractor, Company or Owner PeAorming Ins 'on) ay Phone Number
c�' ,� C l��d1UQI�M� ( 651) 846-291t
EB-00001A-12 5/1999 STA E BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY