P - 82917REGIUEST FOR ELECTRICAL INSPECTION
�/1 1��� O Minnesota State Board of Electricity
�fyl 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 `��
/ Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by ihis request. Enter remarks in this space and on the back of ►he whiie copy only.
Calculaie Inspection Fee - This inspection Requesi will not be occ<
Other Fee # Service Entrance Size
Mobile Home Park Stall 0 to 200 Amps
Street Ltg./Traffic Sig. Above 200 Am
Transformer/Generator INSPECTOR•s use oN�v
line Ltg. Xfmr.
mote Conhol
� Pool
Boom e� ..
without the correct fee:
Fee # Circuits
0 to 100 Amps
Above 100 Amp:
+rTOTAL
that I inspecled fhe electrical installafion deuribed herein on the dafes stated
Fee
15.501
Imestigative Fee r���� �� �2/��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
, OFRCE USE ONLY T{iis request wid 18 months from validalion date prinled in Fhis box�.
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PLEASE PRINT OR TYPE
Requesf Date Rough-in inspection required$ ❑ Yes �No Inspection Olher Than Rough-In: �[] Ready Now ❑ Will Call
6-10-98 {You must call tl�e inspector when ready� Date Ready:
I, � licensed wniractor ❑ owner hereby request inspection of the above electrical work at:
Job Addreu (Sheet, Box, or Route No.) City Zip Code
7637 Arthur St NE Fridley 55432
Section No. Tow�shio Name or No, Ran9e No. Fire No. Couny
Anoka
Occupanf � Phone No.
Jack Kirk 784-1682
Power $upplier Address
Eleckical Contracfor �Company Name) Conhacfor License No. Mazter Lic. No. �Planl
Total Electric, Inc. CA02749
Mailing Address �Conhactor rn Ow�er Per4orming Installation)
1537 �2nd Ln NE Blaine MN 55449 ��_� ,. w:.� '
Authoriz iqnature (Conhactor or Owner PerFpbnins� InstalbtionL � -Phone No.
/�. �' i
A-11 8/96 �
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY