P - 82639REQUEST FOR ELECTRICAL INSPECTION
4(S T� � C p C Minnesota State Board of Electricity
� V J O�J 1821 University Ave., Rm. S-128, St. Paul, MN 55104 ��'��`
Phone (612) 642-0800 '���
Home Duplex X Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this reqvest. Enter remarks in �his space and on the back of the white copy only.
Reconnect furnace
Calculate Inspection Fee - This Inspection Reqvest will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. � 1 5. 5 �
Alarm/Remote Control
Swimming Pool
I hereb ceAi that I ins cted the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Dare
Special Inspe ' n
Final D
Investigative F --�f 1 �
THIS INSTALLATION MAY BE ORDERED DIS CTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLV This request void 18 months from validation date printed in this box.
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* � 4 � 7 5 8 5 9�K PLEASE PRINT OR TYPE
Request Date Rough-in inspection required? ❑ Yes � No Inspection Other Than Rough-In: � Ready Now ❑ Will Call
12 - 0 3- 9 6 (You musf call fhe inspecfor when ready) oafe Read,.: 12 - 0 3- 9 6
I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Jo6 Address (Sireet, Box, or Route No.) Ciy Zi Code
6487-5th.St.NE. Fridley P55432
Section No. Township Name or No. Range No. Fire No. Counly
Occupanf Phone No.
Village Green Townhouse 574-0674
Power Supplier Address
NSP.
Elecirical Contractor (Company Name) Confractor License No. Masier Lic. No. �Planf Elect. Only�
Brandon electric,Inc. CA00307
Mailing Address (Confrador or Owner Performing Insfallafion)
O1 Colfax Ave.NO.Brooklyn Park,MN 55444
Aufhori ed S at re (Confmctor or Owner Performing Insfallafion) �,�-�----° �� �", Phone No.
; � � � ' , ��' � 560-5311
EB-00001 A-11 8 6 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY