P - 82506�
1 ro2o-411 � REQUEST FOR ELECTRICAL INSPECTION E
Minnesota State Board of Electricity
' 1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 -
(651) 642-0800 www.e/ectricity.sfate.mn.us :;� -
x Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Loatl Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
'X" above the work covered by this request. Enter remarks in ihis space and on the back of the white copy on/y.
NSP SAVER'S SWITCH
Calculate lnspection Fee - This lnspection Request will not be accepted without the correct fee.
I�stallations Fee # Service Entrance Size Fee # Circuiis / Feeders
Mobile Home Park Stall
Street Ltg. / Tratfic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
0 to 100 Amps
Above 100 Amps
TOTAL
ZQ.SQ
....7'"..".. ""°'� `-' - Raugh In Date
Special Inspection
Final A �
Investigative Fee .—�c9
THIS INSTALLATION MAY BE ORDERED DI ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
�}�r�•�;,�� r}�,�•.� � r� _ _. . ,�".w �� OF'FICE USE ONLY This reques[ vad 18 months from validatlon date printed in this box.
I II�I�I IIIII IIIII II�II �IIII II I� II�I I,II
* 1 0204 3* ���j3'y� �
' � �sv PLEASE PRINT OR E
flequest Date Rough-In inspection required? ❑ Yes � No Inspection Other Than Rough-In: � Ready Now ❑ Will Call
� 2% � 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 No.) City Zip Code:
146 83f� WAY f� FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. Cou�ty ���
�1fK71i�M
Occupant Phone No.
LAfVGIEVilICZ � R
Power Supplier � f Address
�
Electrical Contractor / Com an Name Contract r Li n o. Master Lic. No. (Plant Elect. Ony)
HUNT ELEGeT�TlC CORPORAT14A1 C�► O�
Mailin�s,��i�`I'�� �°,`���`'�AUl., IuiM 56114
Authoriz gnatu ractor, Company or Owner Perfarming Installation) Phone Number
� es�j e�e-z� 1
EB-OOOOtA-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY