P - 8279466���'g�8 �
X Home Duplex
Commercial Industrial
x Air Cond. g Htg. Equl
Dryer Range
"X" above the work covered b
RE(�UEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity '�
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 `'�'
Other: New Addn
Farm
Water Htr. Lc
Elec. Heat T�
request. Enfer rem�
Mgmt. Other:
Service
in this space and on the
Remod
copy
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stail 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL 15 . 5�
Sign/Outline Ltg. Xfmr.
Alarm/Remote Confrol
Swimming Pool
I hereb certi that I ins the electricol installation described herein on the dafes stated
Irriqqtion BoOm R��al,-�� Dare
' � ' Firwl � Da
Investigati�e Fee �Q - ^2 3^ '�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
, OFFICE USE ONLY This request void 18 months from va�idation date prinfed in this box.
i�iiiiliiiiiiiiilii�iiii�����i� �► `�'�
* 0 b 6 8 8 8 8 1* ����
PLEASE PRINT OR TYPE
Requesf Date Rou h-in in tion r uired? ❑ Yes
7-30-98 9 � � �] No Inspection Other Than Rough-In: j� Ready Now ❑ Will Call
�You must call the inspecror when ready) Date Ready:
I, [� licensed contractor ❑ owner hereby request inspection of the obove electrical work at:
1ob Address (Sfreet, Box, or Route No.) Cify Zip Code
5364 Horizon Dr FRidley 55421
Section No. Township Name or No. Range No. Fire No. County
Occupant
Dan Balego
Electrical Conhacfor (Company NameJ
Total Electric Inc.
Mailing Address (Conhactor or Owner PerForming Installationj
1537 92nd Ln NE Blaine MN
Authorized Si fure IConhacror or Owner PedOrmina Installc
Conkacfor License N<
CA02749
Phone No.
STATE BOARD COGY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
572-1021
No.
786-8484