P - 822121`011-443 07 REQUEST FOR ELECTRICAL INSPECTION ���E
Minnesota State Board of Electricity ti:-
- 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 -__ _
(651) 642-0800 www.e/ecfricity.state.mn.us : :
x Home Duplex Apt. Bitlg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Loatl 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 tne wnite copy onry.
NSP 3AVER'S SWITCH
Ca/cu/ate Inspection Fee - This Inspection Request will not be accepted without the correct fee.
Dther Installations Fee # Service Entrance Size Fee # Cirouits / Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Ai
Street Ltg. / Traffic Sig. Above 200 Amps Above 100
TransformeNGenerator INSPECTOR'S USE ONLY
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Poo�
f hereby cerli(y that I ins cted Itie electrical installation described h
Irrigation Boom Rouyh In
e.,e..��i i.,�..e..�.� �. _ �
TOTA� __ a0's-D I
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on the dates stated:
I I Investigative F� V��� � rp� � �' — ��r Z-J 'a �J
THIS INSTALLATION MAY BE ORDERED NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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I IIIIII IIIII IIIII IIIII IIIII II I IIIII II� I�I OFFlCE USE ONLY This requast vdd 18 months fram validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes ❑ IJ� InspecUon Other Than Rough-In: LJTeady Now � Will Cell
�2��� 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 Z�P �e�
1361 TSTH A1fE NE FRIDLEY 56432
Section No. Township Name or No. Range No. Fire No. Caunty
-------'° ------ -----------° --------^ I"u.��
Occupant Phone No.
PETER3QN PAUL A ------
Power Supplier � t Address
NSP • �� ------------
Electrical Contractor / Company Name Contractor License No. Master Lic. No. (Plant Elect. Only)
H LECTRIC CORPQRATION CA 00883
Mailing Address (Contractor, Company or Owner Performing Installation)
23aQ TERRITORIAL ROAD , SAINT PAUL, MN '55114
Authorized Signature (Contractor, Company or Owner Performing Installation) Phone Number
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EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY