P - 82209REQUEST FOR ELEC7RICAL INSPECTION � °E
1-011-439 0 Minnesota State Board of Electricity
' 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 -
(651) 642-0800 www.e/ectricity.state.mn.us
X Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Contlitioner 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.
N3P SAVER'S SWITCH
Ca/cu/ate Inspection Fee - This Inspection Request wil/ not be
�ther Installations Fee # Service Entrance Size Fee
Mobile Home Park Stall 0 to 200 Amps
Street Ltg. / Traffic Sig. Above 200 Amps
Transformer/Generator INSPECTOR'S USE ONLY
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereby
Irrigation Boo Rough In
I inspected the
without the correct fee.
Circuits / Feeders Fee
0 to 100 Amps
Above 100 Amps
TOTAL
--�ao-s�
�n described herein on the dates stated:
Date
Investigative Fee _ r� � ���-- - I�iZ_ / 2—�'� I
THIS INSTALLATION MAY BE ORDERED NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
.............................. ......... ............................ . . _ ......... ........ .......... ................................. ..................... . ....... .....
-- �,_._.�� ,.......��_____ ,�..
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I IIIIII (IIII I'III IIIII (IIII III III� �II �I OFflCE USE ONLY Th�s requent vad 18 monUis from validation date printed in this box.
�O. ,,/�
* 1 0 1 1 4 5* � ��QS
PLEASE PRINT OR TYPE
Request Date Rou h-In ins ection re uired? ❑ Yes ❑ N� Ins ection Other Than Rou h-In:
g p q p g �eady Now ❑ Will Call
����� You must call the inspector when ready! Date Ready:
I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electricai work at:
Job Address (Street, Box, or Route No.) Ciry Zip Code:
?t1 56TH AVE NE FRIDLEY 5543Z
Section No. Township Name or No. Range No. Fire No. County
------- ------ ---"'_•__.__" ----------- �4I�
Occupant Phone No.
' HILL LARRY N ------
Power Supplier Address
NSP c� .� _ ------------
Electrical Contractor / Company Na e_.,� � Contractor License Na. Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor, Company or Owner Performing Installation)
2304 TERRIT�C)RIAL ROAD , SAINT RAUL, MN 55114
Authorized Signature (Contrador, Company or Owner Performing Installation) Phone Number
l
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF VELLOW COPY