P - 83341RECiUEST FOR ELECTRICAL INSPECTION ����
Ca O�- 215 0 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 ''�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air x Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by ihis request. Enier remarks in this space and on the back of ihe white copy only.
Replacement Furnace & AC
Calculate Inspection Fee - This Inspection Request will not be accepied without the correct fee:
Other Fee # Service Entrance Size Fee # CircuitsJFeeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Tra$ic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL 15 . 5�
Sign/Oulline Ltg. Xfmr. Q
Alarm/Remote Conhol �1
Swimming Pool
I hereb certi fhat I ins ted fhe elechical installafion described herein on the dates stated
Irrigation Boom RouaMo Dare
Investigative Fee � � � De - — I�� 2 3" �
THIS INSTALLATION MAY BE ORDERED DISCONN TED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlGE USE ONIY This raquest void 18 months Erom validation date printed in ihis box.
��i��liil�����i{NI���I�N�I�����������I���� t • �-\ - �
* � 6 8 9 2 1 5 2* 2��j�j ���9
PLEA�E'PRiN��O� TYPE
Requesf Dafe 10�22�98 Rough-in inspection required? ❑ Yes Q[No Inspecfion Ofher Than Rough-In: � Ready Now ❑ Will Call
�You must cal� the inspecfor when ready) Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sfreet, Boz, or Route No.) City . Zip Code
5337 Horizon Dr Fridley 55432
Section No. Township Name or No. Range No. Fire No. � County
Occupant Phone No.
Tim Furlong 571-5369
Power Supplier Address
Eleclrical Conhactor (Company Name) Confractor License No. Masfer Lic. No. (Plant Elec
Total Electric Inc. CA02749
Mailing Addreu (Conhactor or Owner Performing Ins�allation)
10760 ankato St Ne Blaine MN 55449
Aulhorized Sig re (Conhactor or Owner Pe�{orm' g Installafion) Phone No.
- - /� �� � 786-8484
STATE BOARD dOPY - SEE INSTRUCTIONS�RBACK OF YELLOW COPY