P - 82210��1 'O� � _i14-� � REQUEST FOR ELECTRICAL INSPECTION �' �E
� `t Minnesota State Board of Electricity
�✓ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 _—_ _
(651) 642-0800 www.e/ectricity.state.mn.us : `"�
X 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 ln tnis space ana on tne paCK or rne wn�re copy onry.
Calculate Inspectii
�ther Installations
Mobiie Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
NSP 3AVER'S SWlTCN
Fee - This Inspection Request will not be accepted without the correct fee.
;e # Service Entrance Size Fee # Cirouits / Feeders Fee
0 to 2Q0 Amps 0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TOTAL
� ao.s�
I hereby certi that I inspected the electrical installation described herein on the dates stated:
� Rouah In Date
Investigative Fee � �' I Dat��� �� I
/
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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I��I�I1 I�III I�) �I�I� II �I II I I� �I OFFICE USE ONLY This requert vad 18 rtrontl�s from validation date printed in this box.
1 I) I �II�I V�V-�
* 1 0 1 1 4 1* � �� ��
PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes O N0� Inspection Other Than Rough-In: LJ�Ready Now ❑�II Call
�2��� Yau 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:
542 68'TH AVE NE FRIDLEY 55432
Seclion No. Township Name or No. Range No. Fire No. County
__••__° -°--- ------""--- ----------- ���
Occupant Phone No.
FROGH JACQUELINE R ------
Power Supplier Address
NSP O �'? -----------
Electrical Contreaor / Company Name Contractor License No. Master Lic. No. (Plant Elect. Only)
HUNT ELECTRiG G4RPORATION CA 00983
Mailing Address (Contractor, Company or Owner Pertorming Installation)
230D TERRITORIAL ROAD , SAINT PAUL, MN 5511♦
Authorized Signature (Contractor, Company or Owner Performing Installation) Phone Number
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EB-OOOOtA-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY