P - 82636�....YE
1�014-998 07 REQUEST FOR ELECTRICAL INSPECTION �`°°°'..
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Minnesota State Board of Electricity � i,-
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
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. (651) 642-0800 www.electricity.state.mn.us . :
'X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
h1�R SAVER'� SWITGFi
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee.
Other Installations Fee # Service Entrance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign / Outline Ltg. Xfmr. �'�
Alarm/Remote Control
Swimming Pool
I hereby certify that I inspected the electrical installation described herein on the dates stated:
Irrigation Boom I� Rough In Date
Special Inspection
Final ,. _. �- - � �-. ��3 � C
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
...............................................................................................��_�...,_._ .................-....._...+,,:;,.........................,..LL.�........................
I IIIIII IIIII IIIII IIIII IIIII III I IIIII IIII IIII � OFFICE USE ONLY This request void 18 months from validalion date printed in this box.
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* 1 0 1 4 9 7* ,�L{� �
, PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes ❑ NIS� Inspection Other Than Rough-In: C� Ready Now ❑ Will Call
You must call the inspector when ready! Date Ready:
I, [j�icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code:
5�4� 5 E BRENMER �A� FRtQ�EY 55432
Section No. Township Name or No. Range No. Fire No. County
------ --- ------------------------ - AN9!(A
Occupant Phone No.
P RCE d�UGLAS L
Power Supplier h� Address
NSP �
Electrical Contractor / Company Name Contractor License No. Master Lic. No. (Plant Elect. Only)
HUNT ELE�TRI� CQRPOFcAT1�7N C�i00�3a
Mailing Address (Contractor, Company or Owner Performing Installation)
23�J TERRITORlA.L RC?A.C+ ,�P,lMlT PA.! �L, M�I 55114
Authorized Signature (Contractor, Company or Owner Performing Installation) Phone Number
, �c�CCtotmt � 6�� �-2911
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY