P - 83211RE(�UEST FOR ELECTRICAL INSPECTION
6 4� �- 2 5 0 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
• Phone(612)642-0800 "�'
X Home Duplex Apt. Bldg. Other: New Addn
Com 'ci Industrial Farm Remod Re air
Htg. Equip. Water Htr. Load Mgmt. Other:
D Range Elec. Heat Temp. Service
"X" above the work covered 6y this request. Fnter remarks in this spoce and on fhe back of ihe whi)e copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home�Park Stall 0 to 200 Amps 0 to 100 Amps
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Oudine Ltg. Xfinr.
15.50
Alarm/Remote Conhol
Swimming Pool
I hereb certi thaf I ins the elechical installafion described herein on the dafes sfated
Irrigation Boom Ro„9�„ pa�
SpeciaLlnsp
Investigative ee � ���. — Z- 7 --c
THIS INSTALLATION MAY BE ORDERED DISC ECTE� IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONIY This requesf void 18 months from validation date printed in fhis box.
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PLEASE PRINT OR TYPE
Requesf Date Rou ffin ins fion r uired$ ❑ Yes No Ins ion Ofher Than Rou h In: Read Now ❑ Will Call
6-22-98 s � � � �� s- � r
�You musi call the inspector when reody) pate Ready;
I, �] licensed contractor ❑ owner hereby request inspection of the above elecfrical work at:
Job Addreu (Sheet, Box, or RaRe No.) Ciy Zip Code
1561 Camelot Lane Fridley 55432
Seclion No. Township Name or No. Range No. Fire No. County
Anoka
Occupont Phone No.
Gene Rezac 574-1199
Power Supplier Address
Eleckical Conkactor (Company Name) Conhactor License No. Master Lic. No. (Plant Elect. Only)
Total Electric, Inc. CA02749
Mailing Addresa (Contracfor or Owner Performing InsfallaKon)
1537 92nd Ln Ne Blaine MN 55449
Authoriz gnature (Conhactor or er Performin Insfallafio c � Phone No.
� V �,r 786-8484
EB-00 ` A-11 8/96 STATE BOARD COPY - SEE INSTRUCiIONS ON BACK OF YELLOW COPY