P - 82350-- 'I -020-113 0
E
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity - �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 -_ -
(651) 642-0800 www.electricity.state.mn.us � '
Hame 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 onry.
NSP SA1fER'S SWITCH
Ca/cu/ate Inspection Fee - This Inspection Request will not be
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
without the correct fee.
Circuits / Feeders
0 to 100 Amps
Above 100 Amp:
TOTAL
I hereb certi(y that 1 inspected the electrical installation describetl herein on the tlates stateC:
Irrigation Boo �, i� p�8
Special Insp
Finsl D
Investigative Fee � Z' � -'°�
THIS INSTALLATION MAY BE ORDERED DI ONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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I IIIIII IIIII IIIII IIIII IIIII II II I�III IIII (III OFFICE USE ONLY Thia request void 18 rtantlis from validation date printed io this box.
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*10201 5* �e
PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes ❑ N� Inspection Other Than Rough-In: �Ready Now � Wfll Call
�, ��� You must call the inspector when ready! Date Ready:
I, [�icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code:
Section No. Township Name or No. Range No. Fire No. Coun�ty�y�
!'YM�l1
Occupant Phone No.
Power Supplier � � + � Address
-L
Electrical Contractor / Company Name Contractor License No. Master Lic. No. (Plant Elect. Only)
NUNT ELECTRIC CORPOR�"r'ION CA Od!�3
Mailing Address (Contractor, Company or Owner Performing Installation)
230Q TERRiCOR1AL ROAb , SAINT PAUI, IrMi 56114
Authorized Signature (Contractor, Company or Owner Perfortning Installation) Phone Number
�
EB-OOOOtA-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS � BACK OF YELLOW COPY
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