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REC�UEST 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 : `
x Home Duplex Apt. Bldg. Other: New Atldn
Commercial Industrial Farm Remotl 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 tne nacK or tne wnire copy onry.
N3P 3AVER'S 3WITCH
Calculate Inspection Fee - This Inspection Request will not be
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
AlarmlRemote Control
Swimming Pool
Irrigation Boom
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I herebv certiTV that 1
without the correct fee.
Circuits / Feeders
0 to 100 Amps
Above i 00 Amps
herein on the dates
Investigative Fee F��e� � �–�` I G—�"�� � �
THIS INSTALLATION MAY BE ORDERED DI ECTED IF NOT COMPLETED WITHIN 18 MONTHS._
_._._..._ .. ...................�,..,.. �:..._..... . . . . . ...::....�- .�::::.............,n....n.....,.,.,.,....
OFflCE USE ONLY This request void 18 months from validation date printed in this box.
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*08582934*
PLEASE PRINT OR TYPE
Request Date Rou h-In ins eciion
g p required? � Yes ❑ o Inspection Other Than F?ough-in: eady Now � WNI Call
� �%�� You must cail the inspector when readyt Date Ready:
I, �] licensed contractor ❑ company ❑ owner hereby request i�spection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code:
�1b HtJG+D ST NE fRtDf.EY 564�2
Section No. Township Name or No.�_. Range No. Fire No.�Y— Countyw `�A
AIParM
Occupant N��� Lt� � Phone No. �_
Power�plier Adtlress �
P
Electrical Contractor / Comparry Name Conhac[or License No. Master Lic. No. (Plant Elect, Only)
HUNT E�ECTRtC ��PC►RATION CA 04�83
Maili�g Address (Contractor, Company or Owner Performfng Installation)
2300 TERRit4�tiAL RC3�lD , SAlNT PAUI, MM 56114
Authorized Signature (Con ractor, Company or Owner Pertorming In I on) Phone Number
� r� �.�OdlGMR ( &�►'� 646-284?
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY