P - 83210REQUEST FOR ELECTRICAL INSPECTION
�` � � � � /I � � Minnesota State Board of Electricity
V �'a 1821 University Ave., Rm. S-128, St. Paul, MN 55104
� Phone (612) 642-0800 '��
X Home Duplex 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 request. Enter remarks in this space and on the back of the white copy only.
Calculafe Inspection Fee - This Inspection Requesi will not be accepted without the correct fee:
Other Fee # Service Entranc ize Fee # Circuits/Feeders Fee
Mobile Home PAYk Stall 0 to 00 Amps 25 . 0 to 100 Amps
Street Ltg./Traffic Sig: Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Oudine Ltg. Xfmr. 25.5�
Alarm/Remote Control
Swimming Pool
I hereb certi thof 1 ins ected fhe electrical installation deuribed herein on the dates stated
Irrigation Boom Ro�h-I� Dare
Special lnspecri -
Investigative Fee Final �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesi void 18 months from validafion date printed in this box.
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* 0 6 4 1 2 4 7 2* Tld `7
PLEASE PRINT OR TYPE
Requesf Date Rough-in inspecfion required? ❑ Yes
� No Inspecfion Other Than RougMn: � Ready Now � Will Call
6-25-98 n'ou must call the inspecfor when ready) Date Ready:
I, [�licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sheet Bwc, or Route No.) Ciy Zip Code
25 66 1%2 Way Fridley 55432
Secfion No. Township Name or No. Range No. Fire No. Couny
Anoka
Occupanf Phone No.
Ma.rk Hove 586-9712
Power Supplier Address
NSP North Div. 3115 Centre Point Dr Roseville MN 55113
Elechical Conhacbr �Company Name) Conhacfor License No. Master Lic. No. (Plant Elect. Only�
Total Electric Inc. CA02749
Mailing Address (Conkacfor or Owner Performing Insfallation�
1537 92nd Ln NE Blaine MN 55449
Authorized ' re (Confracfor or Owner Performing In Ta oti c� Phone No.
� ��G ��j-' 786-8484
EB-0 A-11 8/96 STATE BOARD COPY - SEE INSTRUCTiONS ON BACK OF YElLOW COPY