P - 82188,1�-011-445 [2�
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REQUEST FOR ELECTRICAL INSPECTION -
Minnesota State Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 -_ -
(651) 642-0800 www.electricity.stafe.mn.us
'X" above the work covered by this request Enter remarks in this space and on the back of the white copy only.
Mobile Home Park Stall
Street Ltg. / Tra� �ig,
/ Outline Ltg. Xfmr.
NSR SAVER'3 31MlTCN
Fee - This Inspection Request will not be
0 to 200 Amps
Above 200 Amps
INSPECTOFi'S USE ONLY
Rough
that I
cepted without the correct fee.
# Circuits / Feeders F
0 to 100 Amps
Above 100 Amps
TOT�,�s„
�7�1'OV
��: .
installation described herein on the dates
. . Flnel . ! e— � / 6/ �d J
Investigative T
THIS INSTALLATION MAY BE ORDERED DI NECTED IF NOT COMPLETED WITHIN 18 MONTHS. +
,..,.._,._._._ ........................�.,._................,.......�..,..........1.,..�.._..,,..._,__,_,_.,_ ...,.....,....,•�:..........��...,.:;�,.......-• •• ---�
OFFICE USE ONLY This request void 18 mo ns from validation date printed in this �box.
IIIIIIIINIIIIIII811lIIIlIIIII II(IIINI�I a� _;� .
*y 0� 14 2* � ��J-r'
PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? � Yes � N� Inspection Other Than Rough-In: L�'Ready Now 0 Will Cail
�27t� You must call Me inspector when ready! Date Ready:
I, [Xj licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, a Route No.) Ciry Z�P C��
�645 AIVUKA �T NE FRfDIEY �54�2
Section No. Township Name or No. Range No. Fire No. Couniy
___._ _._ . __ _____.__. ���
Occupant Phone No.
tOND�� BECKY ,1 ------
Power Supplier Address
NSP ,- --._..__..._
Electrical Contracror / Company m Contracror License No. Master Lic. No. (Plant Elect. Only)
HUNT ELECTRIG GCRP�RATI4N GA 00883
Mailing Address (Contractor, Company or Ownet PeAorming Installation)
23QQ TERRI'fC)RIA! RQAD , SAINT PAUl, MN 56114
Authorized Signature (Contractor, Company or Owner Pertorming Installation) Phone Number
� B5'� B4B-28? 7
EB-00001 A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY