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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 Universiry Avenue Sulte S-128, Saint Paul, Minnesota 55104-2993 _ _
(651) 642-0800 www.electricity.state.mn.us r '
Home Duplex Apt. Bidg. Other: New Addn
Commercial Intlustriai 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 of the white copy on/y.
N3P 3AVER'3 3WtTCH
Ca/culate Inspection Fee -
�ther Installations Fee
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr,
Alarm/Remote Control
Swimming Pool
Irrigation Boom
will not be
0 to 200 Amps 0 to 100 Ai
Above 200 Amps Above 100
INSPECTOR'S USE ONLY
I hereby certify that I inspected the electrical installation described h
Hough In
correct
Date
Amps
� � Investigative Fee — T' + � �/" _„�.�� � � � -���p'"�
THIS INSTALLATION MAY BE ORDERED SCONNECTED iF NOT COMPLETED WITHiN t8 MONTHS.
W V.M�M».�.YWY r.y V w�,����� �w� W�.��w W���w� OFFICE USE ONLY This request vad 18 rtantlre trom validation date printed in this box.
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*0859&595* O��
PLEASE PRINT OR TY
Request Date Rough-In inspection required? � Yes ❑ No Inspection Other Than Rough-In: O Ready Now ��II Call
���� You must call the inspector when ready! Date Ready:
I, �] licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address Street, Box, or Route Na. City Zip Code:
�ttJ 62112 i�IAY NE FRfdZEY 55433
Section No. Township Name or No.���Y_ Range No. Fire No. Counry �—aL_
rYR�
o�'�nt PERRY GENE R PhOOe "°. -----
Power�ppplier Address ,
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Elechical Contractor / Company Name CoMractor License No. Master Lic. No. (Plant Elect. Ony)
HUNT ELECTRiC CORP�RATION GA 00883
Mailing Address (Contractor, Company or Owner Performing Installation)
2300 TERRITORIAL RC)�►D , SAINT PAUL, MN �114
Authorized Signature (Contra C�n�n� r $wner Performing'ins I'on) Phone Number
� � � 1 J��Ci�rdwlr� ( .,1) 84�Z8�t 4
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY