P - 82072REQUEST FOR ELECTRICAL INSPECTION
' O—p5�-799 []9 Minnesota State Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
, (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 on/y.
Caicuiate inspection
�ther Installations Ff
Mobile 4iome Park Stall
Street Ltg. / Traffic Sig.
TransformerlGenerator
Sign / Outline Ltg. Xfmr.
AlarmlRemote Control
Swimming Pool
Irriaation Boom ,
Fee - This
N3P SAVER'S SWITCH
will noi be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
�. k ii�(�
_ ROUyh
without the correct fee.
�ircuits / Feeders
0 to 100 Amps
Above 100 Amp:
TOTAL
•�'�
_ ao.s�
W r.i� r� Y. dates stated:
nvestigative Fee — -- `-' "'
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED 18 MONTHS
~���M�W W��m���� OFFICE USE ONLY This request vokl 18 monlhs from validation date printed in this box.
IIIIII IIII� I�I�� ��III I�III II�I��II IIII �I�I � �V '�
*Q8597999* ��l`3
PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? 0 Yes � NO Inspection Other Than Rough-In: LJReady Now 0 Will Call
��4�� You must call the inspector when ready! Date Ready:
I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Sox, or Route No.) City Z�P C��
562 FAIRhAONT ST NE FRIDLEY a5d32
Section No. Township Name or No. Ra�ge No. Fire No. County
---�-•-- ---- ---- ---^ --..._�--- /'Yl�i1W
OccupaM Ptwne Na
PROKOP CEGIL A -----
Power Supplier Address
NSP _______..
Electrical Contractor / Company Name Contractor License No. Master Lic. No. (Plant Elect Only)
Mailing Address (Contrector, Company or Owner Performing Installation)
2300 TERRIT+DRIAL R+DAD , SAIF�I' PAUL, MN 55114
Authorized Signature (Contractor, Compankor Owner Performing Installation) Phone Number
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E&00001 A-12 5/1999 STATE B�A COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY