P - 82199C�Q REQUEST FOR ELECTRICAL INSPECTION �` E
� —O � � —�vv � 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 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 on/y.
N3P 3AVER'3 SWITGH
Calculate Insnection Fee - This Inspection Reauest will not be accepted without the correct fee.
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irriaation Boom ., /
0 to 200 Amps
Above 200 Amps
1NSPECTOR'S USE ONLY
# Circuits / Feeders Fee
0 to 100 Amps
Above 100 Amps
TOT��.
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installation described herein on the dates stated:
Investigative Fee � � I Dat „n p-,�� I
" 4V
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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1 II��I� �II�I �I�I� I�I�) IIII� III I�I I� �� OFRCE USE ONLY This request vdd 18 manths from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rou h-In ins
g pection required? 0 Yes ❑ o Inspection Othe� Than Rough-In: eady Now O�II Call
����� 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.) City Zp Code:
563 JANE31/fLLE ST NE FRIDtEY 5643't
Section No. Township Name or No. ��wYM Range No. Fire No. -�� County�a�
Occupant HAMM JtlDY L Phone No. _____'
Power ;uCppj�er �q � Address
1'1 V P """"•"'
Electrical Contractor / Company Name Contractor License No. Master Lic. No. (Plant Elect. Onty)
HUNT ELECTRIC GORPO ATION CA 4QS83
Mailing Address (Contractor, Company or Owner Performing Instailadon)
230Q TERRITORIAL RQAD , SAINT PAUL, MN 55114
Authorized Signature (Contractor, Company or Owner Performing Ins a'on) Phone Number
��If� ( BS'� B4B-2811
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY