P - 81520REQUEST FOR ELECTRICAL INSPECTION
'7� ��(� �� Minnesota State Board of Electricity
c J 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Indushial farm Remod Re air
Air Cond. Htg. Equip. Water Hh. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above ►he work covered by this request. Enter remarks in this space and on the back of the whi►e copy only.
Feeder repair and 1 circuit
Calculate Inspection Fee - This Inspection Request will not be accepted wi►hout the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR�S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr.
Alarm/Remote Conhol
Swimminq Pool
fhat I ins ed the elechical installafion described herein on fhe dafes stated
Dafe
15.50
Investigative Fee "°`�„29�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
_. OFFICE USE ONLY This request void 18 months from validafion date printed in this box.
I�IIIIIIIIIIIIIIIIIIII�luill � lsSa
IIIIII���I�
* 0 7 3 7 9 2 2 5* /��'-fa
PLEASE PRINT OR TYPE
Request Date Rou ffin ins
3-26-99 9 P��ion required? ❑ Yes [�No Inspecfion Other Than RougMn: �Ready Now ❑ Will Call
(Vou musf call the inspecfo� when ready) Dafe Ready:
I, � licensed conhactor ❑ owner hereby request inspection of the above elechical work at:
Job Address �Streef, Box, or Rouie No.) City Zip Code
1021 Hathoway Lane NE Fridley
Section No. Township Name or No. Range No. Fire No. County
Occupanf
Phone No.
Eric Kuubits 571-5890
Power Supplier Address
Elechical Contraclor �Company Name) Conhacfor License No. Master Lic. No. �Planf
xxxxxxxx Total Electric Inc. CA02749
Mailing Address �Conhactor or Owner Performing Instailation�
10760 nkato St NE Suite 1 B 55�+49
Authwiz i alure (Conhactor or �� ir N.ryo� ` Phone No.
T �
Y
STATE BOARD