P - 83902REQUEST FOR ELECTRICAL INSPECTION
� Minnesota State Board of Electricity
`�; ������ � 1821 University Ave., Rm. S-128, St. Paul, MN 55104
�;
Phone (612) 642-0800 '�•
Home Duplex
Commercial Industrial
Air Cond. ` Htp. Equi
"X" above the work
Apt. Bldg. Other. New
Farm Remod
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
requesi. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This lnspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance ize Fee # Circuits/Feeders Fee
Mobile Home Park Stall j 0 to 200 Amps ; 25 . 00 ,5 0 to 100 Amps 25 . QQ
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR•s use oN�v ' TOTAL
Sign/Outline Ltg. Xfmr. �� ����� � f� 50. 50
Alarm/Remote Control ���' s
Swimming Pool
I hereb certi fhaf I ins ted the electrical installation described herein on the dafes stated
Irrigation Boom Rough-In Dafe
Special Inspection
Final � Date
Investigative Fe �Q .�
THIS INSTALL 1 ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� .�. �_, _._ .,., � �— �— �— — — — —� — — — — — — -- -- — � -- �— --- -- �— —.._ —.
OFFICE USE ONLY This request void 18 months from validation date prinfed in ihis box.
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* � 5 L 9 9 7 7 3 7k PLEASE PRINT OR TYPE ��Q
Requesf Date Rou h-in ins ecfion re uired? ❑ Yes
g p q � No Inspection Other Than Rough-In:. �j Ready Now ❑ Will Call
10-23-9 7 (You must call the inspector when ready) Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
1ob Address (Sfreet, Box, or Route No.) City Zip Code
6566 Brookview DR Fridley 55432
Section No. Township Name or No. Range No. Fire No. County
ANoka
occopanr
Steve Flatum
Power Supplier
NSP North Division
Elechical ConMactor �Company Name)
Total Electric Inc
Moiling Address �Conhacfor or Owner Per6
1537 92nd n NE B:
Authorized Signafure� nhactor or Owner
Phone No.
572-0974
Address
3115 CEntre Point Dr Roseville MN 55113
CA02749
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786-8484