P - 821901=011-446
!
a REQUEST FOR ELECTRICAL INSPECTION �
Minnesota State Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.e/ectriciry.state.mn.us : ''
x Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner 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.
IdSP 3AVER'S 3WITCH
Ca/culate Insvection Fee - This Insvection Reauest will not be accevted without the correct fee.
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransformedGenerator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irriaation Boom O f
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I
In
# Circuits / Feeders Fee
0 to 100 Amps
Above 100 Amps
TOT�9J�,.,�_
�31iee�7"
installation described herein on the dates stated:
L � Investigative Fee I I L.i���-- - I/, J'/ �—� I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED W HIN 18 MONTHS.
......... ...... ... ......<.. - --- �.u.u......».. _, _..., �•,.•.. �.••�
u z �.OFFICE USE ONLY This request void.l8 months from validation date printed in ihis box.
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* 1 0 1 1 4 0* -��
Request Date Rough-In inspectlon required? � Yes � �
Q�/�%/QQ You must call the inspector when ready!
��
PLEASE PRINT OR TYPE
Inspection Other Than Rough-In: eady Now 0�II Call
Date Ready:
I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) Ciry Zip Code:
74�f GENTRAf. AVE NE FRfDLEY 5543i
Section No. Township Name or No. Range No. Fire No. Countyw',�yy�
°------° "_--- °---------- M1.IM
Occupant Phone No.
KENNEDY T�QDD ALAN ------
Power Supplier Address
NSP •-----------
Electrical Contractor / Company Name Contractor License No. Master Lic. No. (Plant Elect. Onty)
HUNT ELEGTRIC C�RPGRATI4N CA 00�83
Mailing Address (Contractor, Company or Owner Performing Installadon)
2304 TERRff4RIAL RUAD , SAINT PAUL, MM 55114
Authorized Signature (Contractor, Company or Owner Performing Installa'on) Phone Number
l��vAt� ( Bb'� 646-28? 1
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY