P - 81146� REQUEST FOR ELECTRICAL INSPECTION �"�E '
'�_8�i$_29Q � AAinnesota State Board of Electricity -
�� 1821 University Avenue Suite 5-128, Sain! Paul, Minnesota 55104-2993
(651) 642-0800 www.e/ectricity.state.mn.us
Home Duplex Apt. Bidg. Other: New Addn
Commercial Industrial farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Eiect. Heat Temp. Service
X" above the work covered by this request Ertter remarks in this space and on the back of the white copy on/y.
N3P 3AVf R'S 3WlTGH
Calcu/ate Ins,oection Fee - This Inspection Reauest will not be acceoted without the correct fee.
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
IrriQation Boom
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
Rough In
0 to 100 Ai
Above 100
TOr�
��. �
n on the dates stated:
Date
�pec:iai ms - � y r. �
Investigative Fee . ' � _ �^ ��L—�--E.pl
THIS INSTALLATION MAY BE ORDERED NECTED IF NOT COMPLETED WITHIN 18 MON HS.
���������Mxmµ���.����.� �M� OFFICE USE ONLY This request void 18 months from validation date printed in this box.
I 1�11II IIII� IIIII �IIII I�I�I IIII�� I�11 �i � �J �
*08582983* 76�
PLEASE PRINT OR TY
Request Date Rough-In inspection required? � Yes O No Inspection Other Than Rough-In: � Ready Now � Will CaN
����� You must call ihe inspedor when ready! Date Ready:
I, �] licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Addre ?��eet, �X, T'iST iII�AY NE c�� FRIDLEY Z� 56A32
Section No. Township Name or No.-��'__� Range No. Fire No-��M.r Counryw,���
i�n�✓rv�a
Occupant �R�R �BF�, a Phone No. �
Powe:;uppfier Address �-�N
I�vS��
Electrical Contrector / Company Name Contrador Lrc:ense No. Master Lic. No. (Plant Elec[. Ony)
Hv�rr E�ECr�ic c+o�PORa�naM �a oc�
Mailing Address (Contractor, Company w Owner Performing Installationj
23Q0 TERRITORIAL ROoAD , SAINT PAUL, MN 55114
Authorized Signature {Contractor, Company or Owner Perfortning Inst I ion) Phone Number
r� � ' ' a �J���A�LiMML ( B'S1) 84B-2911
EB-OOOOtA-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPV