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Air Conditioner � � Htg. Equip
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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.state.mn.us `�'
Other: New Addn
Remod Repair
�ryer I I Range I I Elec. Heat I I Temp. Service I
"X" above the work covered by this request. Enter remarks in this space and on ihe back of the white copy only.
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Calculaie Inspection Fee - This Inspection Request will not be accepied wiihout the correct fee:
Other Installations Fee # Service Entrance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TO�
Sign / Outline Ltg. Xfmr. �
Alarm/Remote Control
I herebvi ceAiSv that I insceded ihe eleclrical insMl{alion described herein on Ihe dales sTaFed:
Special Inspection
Final a�
Investigative Fee �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 NTHS.
a� ` ' OFFICE USE ONLY This request void 18 months from validation date prinfed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspection required8 ❑ Yes �No Inspeclion Other Than Rough-In: �Ready Now 0 Will Call .
3 Z � �� You must call the inspector when ready Date Ready:
1, �] licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address �Street, Box, or Rou1e No.) Ciry Zip Code
6431 7th ST NE Fridley 55423
Section No. Township Name or No. Range No. Fire No. County
I Occupanf
Westley Groslie
hical Confractor / Company Name �
Total Electric inc.
ling Address (Confractor, Compony or Owner I
1076�Mankato ST NE
���,
Installafion�
Blai�
Phone No.
763-572-2264
cfor License No.
CA 02749
MN 55449
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STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY