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1—C� 1 1-620 �Q REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
�, � 7821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 -_ =
(651) 642-0800 www.eleCfricity.state.mn.us � r '
X Home Dupiex 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 spece and on the back of the white copy on/y.
Ca/cu/ate Inspecti�
Other Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimrhinq Pool
NSP SAVER'S �MIRT�M
Fee - This Inspection Request will not be acaepted without the correct fee.
�e # Service Entrance Size Fee # Cirouits / Feeders Fee
0 to 200 Amps 0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TOTA �.�
I hereby cert' tliat I inspected the electrical installation described herein on the dates stal
Rough In Date
I � Investigative Fee �'; � (
THIS INSTALLATION MAY BE ORDERED
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I III�II III�I �I��� I�I�I I�III ��� I,il� I�II ��I� OFFICE USE
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ED iF NOT COMPLETED WITHIN 18 MONTHS.
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request void 18 rtwMhs from validaiion date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: LVReady Now O Will Call
�/2�� You must call the inspector when ready! Date Heady:
I, QJ licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code:
6�80 HICK�RIf 51` NE FRIDLEY MN 5543;t42 55492
Sectian No. Township Name or No. Range No. Fire No. County
---------- ------ ------------=-- ------------ �a�►
Occupant Phone No.
JQHNSON DC?NAID E ------
Power Suppliar Address �
NSP � r-� , ------------
Electrical Contractor / Company Name � f Contractor License No. Master Lic. No. (Plant Elect. Only)
HUNT ELEGTRIC CARPQR�ON GA 00883
Mailing Address (Contrector, Company or Owner Performing Instaliation)
23Qd TERRITORIAL ROAD , SAIN'f PAUL, MN 55114
Authorized Signature (Contractor, Company or Owner Perfortning Installation) Phone Number
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EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY