P - 82906�1�-274 �
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
x Home Dupiex Apt. Bldg. Other.
Commercial Industrial Farm
Air Cond. Htg. Equip. Water Htr. Load Mgmi. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of th
Repair Mast
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Calculafe Inspection Fee - This Inspection Request wil not be accepted without the cornect fee:
Other Fee # Service Entrance 'ze Fee # Circuits
Mobile Home Park $tall 0 to 00 Amps 0 to 100 A
Sheet LFg./TrafFic Sig. Above 200 Am s Above l OQ
Transformer/Generator INSPECTOR'S USE ONLY
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Confrol
New
Remod
copy
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Fee
15.50
.,............� ..,.,.
I hereb certi thaf I ins the electrical installation described herein on the dates stafed
irrigation Boom RouyMo Dare
Special lnspectio
inal
Investigative Fee � � �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 8 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validation dafe printed in this box.
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PLEASE PRINT OR TYPE
RequestDate 6_2_gg Rou h-inins ctionr uired$ ❑Yes
9 Pe �1 � No inspecfion O�her Than RougMln: � Ready Now 0 Will Call
�You must call the inspector when ready) Date Ready:
I, [�licensed contractor ❑ owner hereby request inspection of the above elecfrical work at:
Job Address (Sheef, Box, or Route No.� Cily Zip Code
6281 Able St NE Fridley 55432
Secfion No. Township Name w No. Range No. Fire No. Co�nfy
Occupant
Bernice Hyvare
Power Suoolier
aecmwi �ootracror �COmpany Name� Conhactor License �
Total Electric Inc. CA02744
Aailing Address �ConMoctor or Owner Performing InstallaKon�
1537 92nd I� NE Blaine MN 55449
wthorized SignaNre�l,'�acfor or Owner Performing Insial�fion) �n f�
n
Phone No.
571-3025
Lr.r �, � / Lti �'Jy'Y'� , 786-8484
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY