P - 82077E
REQUEST FOR ELECTRICAL INSPECTION
0-859-804 � Minnesota State Board of Electricity Fi- _
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.e/ectricity.state.mn.us :
7C Home Duplex Apt. Bldg. Other: New Addn
Commercial Intlustrial Farm Remotl 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 the white copy onry.
N3P SAVER'S SWITCH
Ca/culate Inspection Fee - This Inspection Request will not
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ON�Y
without the correct fee.
Circuits / Feeders Fee
0 to 100 Amps
Above 100 Amps
TOTA�
ao. sz�
I hereby certi that I inspected the electrical installation described herein on the dates stated:
Irrigation Bo �+- Rough In Date
Speciallnsp o M
Final Dat
Investigative Fee �Z- 2�_ -Q"
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETEO WITHIN 18 MONTHS.
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OFFICE USE ONLY This uest void 18 months from validation date rinled in this box.
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*08598047*
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PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes ❑ Ida Inspection Other Than Rough-In: eady Now ❑ Will Call
�(��� You must call the inspector when readyl Date Ready:
I, �] licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code:
6862 TTH ST NE FRftiZEY 5543Z
Section No. Township Name or No. Range No. Fire No. Counry
°----°° °---- -"--'-'------- -__.___'-» �
Occupant Phone No.
HOB&S FREDERIC ------
Power Supplier Address
NSP � � � e3 � ___._.__
Electrical Contractor / Company Name Contrac[or License No. Master Lic. No. (Plant Elec[. Only)
Mailing Address (Contractor, Company or Owner Performing Installation)
230Q TERRfT'ORIAL RdAD 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