P - 82192�"V � 1-448 � REQUEST FOR EI.ECTRICAL INSPECTION
, Minnesota State Board of Electricity H'�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 - _
(651) 642-0800 www.elecfricify.stafe.mn.us
Home Dupiex Apt. Bldg. Other: New Adtln
Commerciai Industrial Farm Remotl 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 fhe back of the whrte copy only.
NSF 3AVER'S SWITCH
THIS INSTALLATION MAY BE ORDERED DISCQNNECTED IF NOT COMPLETED WtTHIN 18 MONTHS.
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I��II�� ��I�) II��� ����� ��I�I II� ��I�� I�1� ���� OFFICE USE ONLY This request vad 18 months from validatlon date printed in this box.
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PLEASE PRINT OR
Re�jZ�t/� I Rough-in inspecNon required? � Yes 0 No I Inspection Other Than Rough-In: � Ready Now � Will Call
��0 i 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�et, Box, o�� LN NE °i" FR�Dt.EY �P �55432
Section No. Township iVame or No. ���-'„� Range No. Fire No�yM County�Q�
occuPant P�R�. ��A M Phone No.
Power �yQpJier q��
N`�F' � .,
Electrical Contractor / Company Name Contractor License No. Master Lic. No. (Plant Elect. Only)
HUNT ELECTRiC CARPQRATlON CA 00883
Mailing Address (Contractor, Company or Owner Pe�iortning Ins[allation)
23Q0 TERRl1'C?RIA! ROAD , SAINT PAUl, MN 55114
Authorized Signature (Contractor, Company or Owner Performing Installation) Phone Number
Wf'�f�MS' l �-�! pfP'� 1 �
EB•00001A-12 5/7999 STATE BOARD COPY SEE INSTHUCTIONS ON BACK OF YELLOW COPY