P - 82365REQUEST FOR ELECTRICAL INSPECTION HE
�-015'��4 � Minnesota State Board of Electricity '
F, �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 551044993 =-. -
(651) 642-0800 www.electricitystate.mn.us '.°- `'
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 ihis space and on the back of the white copy onry.
NSP SAVER'S SWITCH
Calculate Inspection Fee - This Inspection Request will not be accep�ed without the correct fee.
installations Fee # Service Entrance Size Fee # Circuits / Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
TransformedGenerator INSPECTOR'S USE ONLY T�I�
Sign / Outline Ltg. Xfmr. ,V
Alarm/Remote Control
Swimming Pool
I hereb certity that I inspected the electrical installation described herein on the dates stated:
Irrigation Boom a Rough In Date
Special fnspec
Dat
Investigative Fee � '—� d J
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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OFFICE USE ONLY This request void 18 moMhs from valida6on date printed in this box.
I II I I I I I II II I II II NI I I I I II I I I I IINI lql l�l
* 1 0 1 5 4 7* a�,5o �e� 55�
PLEASE PRINT OR
Re uest Date �`
4 Rough-In inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: Ready Now � Will Call
���� You must call the inspector when ready! Date Ready:
I, [�4icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code:
3i 661R WAY ME FRiDLEY 5643�
Section No. Township Name or No. Range No. Fire No. Counsty�e
' I'�iM
Occupant Phone No.
W4LVERSON DAtAD E
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Electrical Contractor / Company Name Contractor License No. Master Lic. No. (Plant Elect. Only)
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Mailing Address (Contractor, Company or Owner Perfortning Installation)
2300 TERR1TdR1AL ROAD ,�kINT PAU�, MN 56114
Authorized Signature (Contractor, Company or Owner Performing Installation) Phone Number
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E&00001 A-12 5l1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY