P - 84593REQUEST FOR ELECTRICAL INSPECTION -
4 0� - 2 9 6 Minnesota State Board of Electricity
, 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �'
- Phone(612) 642-0800
X Home Duplex Apt. Bldg. Other: New Addn
Commercial Indusfrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above fhe work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will noi be accepted without ihe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall j 0 to 200 Amps 25 , 5 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR•s use oN�v TOTAL
Sign/Outline Ltg. Xfmr. 25. 50
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins fed fhe elecfrical insfallafion dexribed herein on the dates stated
Irrigation Boom RougMn pa
Speciallnspec �l.<Lf- �— �
Final e � �
Investigative F
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This �equesf void 18 monfhs from validation dafe prinfed in fhis box.
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* � 4 � 5 2 9 6 5* PLEASE PRINT OR TYPE
Request Dafe Rou h-in ins fion r uired?
y pec eq ❑ Yes � No Inspection Other Than Rough-In: � Ready Now ❑ Will Call
5/ 2 9/ 9 7 �You musl call the inspector when ready) Date Ready:
I, �licensed contractor ❑ owner hereby request inspection oF the above electrical work at:
Job Address (Sheef, Box, or Route No.) City Zip Code
445 67th Ave NE Fridley 55432
Section No. Township Name or No. Range No. Fire No. County
Anoka
Occupant Phone No.
Ron Widlund 571-1607
Power Supplier Address
NSP North Div 3115 Centre Point Dr Roseville MN 55113
Electrical Conhactor (Company Name) Contractor License No. Masfer lic. No. (Planf Elect. Only)
Total Electric Inc CA02749
Mailing Address (Conhactor or Owner Performing Installation)
1537 9 d Ln NE Blaine MN 554
Authorized Sig re (Confrador or Owner Perfor Ins atio Phone No.
786-8484
EB-0OOOIA- 8/96 STAiE BOARD COPY_ SEE INSTRUC710NS oN aecK nc vF� i nw enov