P - 81142' REQUEST FOR ELECTRICAL INSPECTION � °''
�_8CJ8_QO2 � Minnesota State Board of Electricity
�� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651 } 642-0800 www, e/ectricity. state. mn. us r-'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Contlitioner 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 on/y.
NSP SAVER'3 SWiTGH
Calculate
Mobile Home Park Stall
Street Ltg. ! Traffic Sig.
TransformedGenerator
Sign ( Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Fee - This Inspection Request wili not be
�e # Service Entrance Size Fee
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
Rough In
without the correct fee.
0 to 100 Amps
Above 100 Amps
TOTj�
`"'y`� o�D. S�
electrical installatlon described herein on the dates stated:
r rnvestigative Fee r�� �__��' —�___ I"�°� 2G-- QC% I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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OFFICE USE ONLY This reqoest vdd 18 monHis from validation date printed in this box.
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PLEASE PRMIT OR TY
Request Date Rough-In inspection required? � Yes 0 No Inspection Other Than Rough-In: O Ready Now O Witl Call
����� You must call the inspector when ready! Date Ready:
I, �] licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Addr�S eet, Box, ��� ��C °i� FRIDLEY Zp �Y�7�i
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Section No. Township Name or No._�.�-__ Range No. Fire No�Y_. CountyA �y�A
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o`�°�"` KERSTEN HUWARD 3 Phone Na. ._�
PoweE�er Address �-�Y_._
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Electrical Contractor 1 CAmpany Name Contractor License No. Master Lic. No. (Plant Elect. Only)
HUNT ELEGT'R1C GORPORATtQN CA 00�$83
Mailin�������Y ��P��X�, MW 55114
Authorized Signature (Contractor, Company or Owner Performing I ion) Phone Number
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E&QO�U1A•72 5l1999 A BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY