P - 81154.'
� � 0-858-288 40
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity -
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55704-2993
(651) 642-0800 www.electricity.state.mn.us
Home Duplex Apt. Bldg. Other: New Adtln
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Loatl 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 only.
N3P SAVER�s swrrcH
Ca/culate Inspectic
�ther Installations
Mobile Home Park Stall
SYreet Ltg. / Traffic Sig.
TransformedGenerator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimmina Pool
Fee - This Insnection Reauest will not be acceated wifhout the correct fee.
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
0 to 100 Amps
Above 100 Amps
TOT�,�-
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I herebvi certi(v that I insoected the electrical instaliatlon described herein on The dates statetl:
Special Inspet�ibnf J � -
Investigative Fee � — �e ( %—�%+
� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. �
M��T ����~�T ����� � F� �,� F� �.� � OFRCE USE ONLY This req�st wid 18 monihs trom validatan date printed in this box.
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PLEASE PRINT OR TY
Request Date Rough-In inspection required? 0 Yes O No Inspeckion Other Than Rough-In; Ready Now � 4Y�II Call
11/18/9� You must call the inspector when ready! Date Ready:
I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address Street, Box, or Route No.) Ciry �P ���
5i�7 HIJ+GHES AVE fRIDLEY 664Z1
Section No. Township Name or No.M�-_'�y Range No. Fire Now�--� County�`�A
J'UR�/�1/"l
o`�uP�n� gHREW3BURY ARCHIE K Phone No. _--w
Powe��pl'ier Address
P
Electrical Contractw / Company Name Contrector License No. Master Lic. No. (PIaM Elect. Only)
HUhIT ELECTRIC CORPORATtON CA 00�8:3
Mailing Address (Contractor, Company or Owner Perfortning Installation)
2300 IAL ROAD , SA►INT PAUL, MN fi6114
Authorized Signat ( n ci 7pany or Owner Pertortning`Ins I'on) Phone Number
J�►� ( �?) 848-28Y 7
EB-00001A-12 5/1999 STATE BOARD CAPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY