P - 82367I q B.t..... E.
�'O I 5-485 []4 REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity _ �
� 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 =_ _
(651) 642-0800 www.electricity.sfate.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 back of the white copy on/y.
N5P SAVER'3 SWITCN
Calculate lnspection Fee - This
nstallations Fee #
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
I
will not be accented without the correct fee.
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I
electrical
# Circuits / Feeders Fee
0 to 100 Amps
Above 100 Amps
TO�I�_
50
allation described herein on the dates stated:
Investigative Fee F�� � l� I�� ��"�� I
THIS INSTALLATION MAY BE ORDERED ONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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I II�III,1III IIIII IIIII IIIII III II�I,tII (II) OFFlCE USE ONLY This requeat void 18 moMhs from validation date printed in this box.
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* 1 0 1 5 4 4* o�s� � �
PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes ❑ o Inspection Other Than Rough-In: Ready Now ❑ Will Call
��_� You must call the inspedor when ready! Date Ready:
I, [�4icensed contractor ❑'company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Z�P �e�
700 67TH AVE NE FRfDLEY 55432
Section No. Township Name or No. Range No. Fire No. Counaty��
' AiR/M
Occupant Phone No.
RiCKENBr�iCH JOSEPH S :
Power SuppliP! � Address
��
Electrical Contractor / Company Name Contractor License No. Master Lic. No. (Plant Elect. Onry)
Hurrr E�c-r��e coR�ano� cn aoes�
Mailing Address (Contractor, Company or Owner Performing Installation)
230d TERRITORU�. ROAD , E�AJNT PAUL, MI+1 561 i 4
Authorized Signature (Contractor, Company or Owner Pertorming Installation) Phone Number
� \ �� PR� �
EB-00001A-12 5/1999 STATE BOARD COPV SEE INSTRUCTIONS ON BACK OF YELLOW COPY