P - 83178,
�16-242 �
X Home Duplex
REQUEST FOR ELECTRICAL INSPECTION �� -
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 -
Phone (612) 642-0800 `'�'
Other: New Addn
Commercial Industrial Farm X Remod Re c
Air Cond. Htg. Equip. Water Htr. Load Mgmt. r: 20� A1riP S2TV1Ce
Dryer Range Elec. Heat Temp. Servic Range ClYCUlt COm uter Ckt
"X" above the work covered by rhis request. Enter remarks in this ace and on the back of e white copy only.
Calculafe Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service n ranc S' e Fee # Circuits/Feeders Fee
Mobile Home Park Stall j O�to 00 ps ' 0 to 100 Amps Q,
Street Ltg./Traffic Sig. Above 200 Am s Above ) 00 Amps
Transformer/Generator INSPECTOR's use oN�v TOTAL
Sign/Outline Ltg, Xfmr. �.s�
Alarm/Remote Conhol
Swimming Pool
I hereb certi that I ins the elechical installation described herein on the dates stated
Irrigation Boom RougMn Dote
Special Inspecti
Finol Daf
Investigative Fee �
THIS INSTALLATION MAY BE ORDERED DISC NNECTED IF NdT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date pri�ted in this box.
Iilll llfll IIIIIIIIII IIII�I lll fllll (f �(� � 35. �
� 0 6 1 6 2 4 2 4* 07,� `�J
PLEASE PRINT OR TYPE
Request Da�e Rough-in inspecfion required? ,�: �les No Inspection Olher Than Rough-In: Ready Now ❑ Will Call
5/ 5/ 9 8 (You musf call the inspecior when ready) Date Ready:
I, � licensed conhactor ❑ owner hereby request inspection of the above elechical work ah
1ob Address (Sheef, Box, or Route No.� Ciy Zip Code
1340 66th Ave NE Fridley 55421
Secfion No. Township Name or No. Range No. Fire No. Couny �
Anoka
Occuponf Phone No.
Larson, Carla 571-8546
Power Supplier Address
NSP North Division 3115 Centre Point Drive Roseville 55113
Electricol Conhactor (Company Name) Conhacror License No. Masfer Lic. No. (Plant Elect. Only)
Total Electric Inc CA02749
� Mailing Addreu (Contracfor or Owner PerForming Insfallafion� _
1537 92nd Ln NE Blaine MN 55449
Authorized Signafure (Confracror or Owner Performing Insfallafion) Li ���1� Phone No.
C3 I.�
l..- �� 786-8484
EB-00001 A-11 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY