P - 82366'
1=015-661
� REQUEST FOR ELECTRICAL INSPECTION �"E`�
•.�
Minnesota State Board of Electricity _'�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 -- _
(651) 642-0800 www.electriciry.state.mn.us :;�
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial 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 track of the white copy only.
tv�P �AV�rs swiTai
Ca/cu/ate lnspection Fee - This lnspection Request will not be accepted without the correct fee.
mstaliations 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
Transformer/Generator INSPECTOR'S USE ONLY TO�AIy
Sign / Outline Ltg. Xfmr. zo 50
Alarm/Remote Control
Swimming Pool
1 hereby certity that 1 inspected the electrical installation described herein on the dates stated:
Irrigation Boom � 'l :� Rough In Date
Special lnspection
Investigative Fee F�n� ^ �i—� U
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
�I I�I�� ���I� IIIII �IIII III ~. I I��II ��I �II�^ T.�OFFIG�E 0$E ONLY This request vad 18 �monlhs (rom validation date printed in ihis box.
* 1 0 1 5 6 0* � r� I� ��
PLEASE PRINT OR
Request Date Rough-In inspection required? O Yes 0 No inspection Other Than Hough-In: ❑ Heady Now O Wiil Call
�� ��� You must call the inspector when ready! Date Ready: _
I, [�icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Streei, Bax, or Route No.) Ciry Z�P �e�
374 86i'!i AYE NE FRtDLEY �
Seaion No. Township Name or No. Range No. Fire No. Counly
. �
Occupant Phone No.
MATTSON PAUL D
Power `Sj� f r �` `� ., Address
IY� � U C�x �
Electrical Contraaor ! Company Name Contrac[or License No. Master Lic. No. (Plant Elect. Onty)
HUNT ELECTRtG CORP41�PtTIQN CA 00883
Mailing Address (Contractor, Company or Owner Pertorming Installation)
2300 TERRITORIAL ROAD � SAINT PAUL, MN 56114
Authorized Signature (Contractor, Company or Owner Performing Installation) Phone Number
�lala�ais ( 86�1 �-2911
EB-00001A-12 5/7999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY