P - 82114i
�-(� 1 1_7H9 � REQUEST FOR ELECTRICAL INSPECTION �"�E`
�J Minnesota State Board of Electricity H:-
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 - _
(651) 642-0800 www.e/ectricity.state.mn.us
' Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Load 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 only.
N3P SAVER'S SWITCH
Ca/culate lnspection Fee - This Inspection Request will not be accepted without the correct fee.
�ther Installations Fee # Service Entrance Size Fee # Circuits / Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
TransformedGenerator INSPECTOR'S USE ONLY TOTAL�
Sign / Outline Ltg. Xfmr. �
Alarm/Remote Control
Swimr}Zing Po I
I hereb certify that I in ected the electrical installation described herein on the dat
Irrigation Rough In Date
� � Investigative Fee � � � ( �-c..-1_ _ ��"'. 2, 3—o j �
THIS INSTALLATION MAY BE ORDERED DISC CTED IF NOT COMPLETED WITHIN 18 MONTHS.
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I IIIIII IIIII IIIII III�I IIIII II IIIII �II I�t OFFICE USE ON�Y This request void 18 moMhs from validation date printed in this box.
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PLEASE PRINT OR TY
Request Date Rough-In inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
{}�i�24�� You must call the inspector when ready! Date Ready:
I, �j licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Addr�S eet, BoX, ���AN�iVE NE ��`� FRIDLEY MN �P c 55432
Section No. Township Name or No. _______________ Range No. Fire No. County ��,y�
--------' --° ------°-- ti!
occupant qNQKA CQUNTY Phone No. ._____
Powerw^�oYer / Address
N f' �.+ �� � ,,,, ---------'--
Electrical Contractor / Company Name Contrector License No. Master Lic. No. (PIaM Elect. Only)
HUNT ELECTRIC C4RP4RATI�N CA 00883
Mailiny�nd� �RR or m'p�L ROADPerfSAII�T��1U�.� MN 55114
Authorized Signature (Contrador, Company or Owner Perfortning Ins 'on) Phone Number
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EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY