P - 82879REQUEST FOR ELECTRICAL INSPECTION
(� Z����� � Minnesota State Board of Electricity
G? 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 `' '
Home Duplex Aat. Bidg. Other: New ' Addn
Commercial Industrial Farm Remod . Re air
Air Cond. `. Htg. Equip. X Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/FeedE
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./TrafF+c Sig. Above 200 Am s Above 100
TransFormer�Gene�ator INSPECTOR�S USE ONLY TC
SignJOutline Ltg. Xfmr.
Alarm/Remote Control
Swimmin Pool
15
g I hereb certi that I ins ed the elechical installation described herein on 1he dafes stated
Irripation Boom a���„�� �r�
Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validafion dafe printed in this box.
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0 6 1 6 2 6 3 �*
PLEASE PRINT OR TYPE
Request Dafe 5�,'LQ�(�8 Qo !tin ins tion r
ug pec equired$ ❑ Yes �No Inspection Olher Tkwn Rough-In: [�Ready Now 0 Will Call
(You musf call fhe inspector when ready) Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electricai work at:
Job Address �Sheet, Box, or Route No.) City Zip Code
5298 Fillmore St NE Fridley 55421
Seclion No. Township Name or No. Range No. Fire No. Counly
o�����
Helen Skovran
Electrical Contracfor (Company Name) � Conkacfor License
Total Electric Inc. CA02749
Mailing Address (Conhacfor or Owner Performing Insfallafion)
1537 92nd NE Blaine MN 55449
Authorized Signafure (C cfor or Owner Performinp Install nl �['c. .� ..tii i
Anoka
Phone No.
572-8522
Lic.
jWl/ /`� -�- `' � 786-8484
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY