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REGIUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity �'
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �:
Phone(612)642-0800 ` '
Apt. eldg. Other: New Addn
Farm Remod Re air
Water Hrr. �oad M9mr. Other: Condensate pump
Elec. Heat Temp. Service
request. Enter remarks in this space and on the back of the white copy only.
Colculate lnspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to T00 Amps
Street 1tg./Traffic Sig. Above 200 Am s Above 100 Ai
Transformer/Generator INSPECTOR'S USE ONLY TOT.
Fee
Sign/Oudine Ltg. Xfmr. 15 . 50
Alarm/Remote Conhol
Swimming Pool
I hereb certi thaf I ins the electriwl installation described herein on the dates stated
(rrigation Boom R��� Date
Special Inspectio
Final D� �/
Imestigative Fee �/ Z — 2—�p
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from volidation date printed in fhis box.
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� 0 6 6 8 8 9 8 0* ��Q �
PLEASE PRINT OR TYPE
Request Dafe Rou h-in ins �on r �ired? ❑ Yes
g pecf eq ❑ No Inspecfion O�er Than RougMn: Ready Now ❑ Will Call
8/�/ 9$ (You must call the inspeclor when ready� Date Ready:
I, � licensed conhactor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Roule No.) City Zip Code
5830 6th St NE Fridley 55432
Section No. Township Name or No. Range No. Fire No. County
Anoka
Occupant Phone No. .
Landt. Nina 571-3306
NSP - North
rical Confractor (Company Name� Conhactor License No. Master Lic. No. �Plant Elecf. On
Total Electric Inc CA02749
ing Addreu (Conlracbr or Owner Performing InstallaTion)
1537 nd Ln NE, Blaine MN 5449
xized gn re �Conkocror or Owner P rmi lostallafio Phone No.
� 786-8484
11 8/96 �7ATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY