P - 81140REQUEST FOR ELECTRICAL INSPECTION
� V_858_306 � 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" above the work covered by this request Enter remarks in this space and on the back of the white copy on/y.
NSP SAVER'S 8WPTGH
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee.
�ther Installations Fee # Service Entrance Size Fee # Circuits / Feeders Fee
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
Sign / Outline Ltg. Xfmr. � '
.,
Alarm/Remote Control
Swimming Pool
_. _ I herebvi ceRiN that I insoected the electrical installation described herein on the dates stal
Special Inspe '
Investigative Fee Final Da G^ d��
V
THIS INSTALLATION MAY BE ORDERED NNECTED IF NOT COMPLETED , ITHIN 18 MONTHS. ,,,
..Y ..............._�......_....___.�_,.._._...�._�__,._._.._�,,... _ .. .-° -- -- - - - --... . . .. .. .. _ .. . .
OFFlCE USE ONLY This request void 18 months from validation date printed in this box.
I IIIIII IIII) HIII IIIII �I�I III�� ��I � �O '�
*08583064* �C7�
PLEASE PRINT OR TY
Request Date Rough-In inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: Ready Now ❑��I Cell
� ��� � You 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 ZP ��
�t0 66TH II�AY NE FRICN.EY 5643Z
Section No. Township Name or No.___��N-� Range No. Fire No.�� County�
Occupant ��KLUAID MARSHALL V Phone No. __»»
Powe�yp�er Address ��
tiit'
Electrical Contractor / Compeny Name Contractor License No. Master Lic. No. (PIaM Elect. Only)
HUNT ELECTRiC GORP4RATI4N GA 00883
Mailing Address (Contractor, Company or Owner Performing Installation)
230Q TERRITORIAL RO�AD ,&AINT PAUI, MN 66'114
Authorized Signature (Contractor, Co ny r Ijqforming`Ins I'on) y Phone Number
�r I'+� ( �'� 645-28'11
EB-OOOOtA-12 5/1999 STATE BOARD CAPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY