P - 81238RE(�UEST FOR ELECTRICAL INSPECTION a� �
8������ � Minnesota State Board of Electriciry
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800 ' '
g Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. X Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on ►he back of the white copy only.
replacement furnace
Calculate Inspection Fee - This Inspection Request will not be accepied without ihe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 ro 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL �
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool j� � %!�S'��
I herebvi certifv that I insoected the electrical installation described herein on the dafes sfated
�peciai inspettiom —
Imestigative Fee �� � �� 'Z � —C� z
THIS INSTALLATION MAY BE ORDERED 91SCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
�— - - _ . __ _ _ _ _ _ _ — --- — -- ------
., OFFICE USE ONLY This requeaf void 18 months om validation date printed in this box.
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* 0 8 3 4 2 6 7 7* �ao�
PLEASE PRINT OR TYPE
Request Date RouglFin inspection required$ ❑ Yes � No Inspecl:on Olher Thon RougMn: � Ready Now ❑ Will Call
11 / 5/ 9 9 (You must call the inspector when ready) Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above elecfrical work at:
Job Address (Skeef, Box, or Route No.) City Zip Code
1623 Briardale Fridley 55432
Secfion No. Township Name or No. Range No. Fire No. County
� Occupant
a Miller
Phone No.
(612) 413-1547
Elechical Contracror �Company Name) Conhacror License No.
Total Electric, Inc. CA02749
Mailing Address �Confractor or Owner Performing Insfallafion)
nkato Street NE Suite 4�1 Blaine MN 55449
(Conhacfor or Owner Perforr�'�stallafion W` , r Phone No.
BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY