P - 81250REQUEST FOR ELECTRICAL INSPECTION
, i�,$58_2Qo � Minnesota State Board of Electricity
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 551042993
(651) 642-0800 www.electricity.state.mn.us
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.
NSP 3AVf R'3 SWITCH
Ca/cu/ate Inspectic
�ther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irrigation Boorpn ,�, �
Fee - This Inspection Request will not be
ae # Service Entrance Size Fee
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
that I insoected the electrical
without the correct fee.
Circuits / Feeders
0 to 100 Amps
Above 100 Amos
Date
�
stated:
Investigative Fee Finai /� / �� I Dates �d� I
_ C _IL��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
��^ ��T���. OFRCE II�E ONLY This requnt void te months from validation date printed in this box.
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*08582900* 76�
PLEASE PRINT OR TY
Request Date Rough-In inspection required? � Yes � No Inspection Other Than Rough-In: Ready Now ❑ Will Call
11 /19/9S You must call the inspector when ready! Date Ready:
I, �J licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address Street, Box, or Route No. City Zip Code:
48�27 21/2 S'� N� FRIDI.EY 5542i
Section No. Township Name or No. Range No. Fire No. CountyAN��
Occupant y���GER RfJBERT L P�ne No. �_
Power� upplier Address
SP ------------
Electrical Contractor / Company Name Contractor License No. Master Lic. No. (Plant Elect. Only)
HUNT ELEGTRiG C.QRPORATION CA 00883
Mailing Address (Contractor, Company or Owner Perfortning Installation)
2300TERRtTOR1AL ROiAD , SAINT PAUL, MN 5511�
Authorized Signature (Contractor, Company or Owner Perfortning Ins I'on) ry Phone Number
c �-.� ~ � ` l /rldlAOlZ1� ( 86'� 64B-2S11
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY