P - 82078E
REQUEST FOR ELECTRICAL INSPECTiON
.o=s59-so5 0 Minnesota State Board of Electricity F- `�
1821 University Avenue Suite S•128, Saint Paul, Min�esota 55104-2993
(651) 642-0800 www.e/ectricity.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 pack or tne wn�te copy orny.
Calculate Inspectic
Jther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
NSP 3AVER'S SWITCH
Fee - This Inspection Request wili not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
without the correct fee.
Circuits / Feeders Fee
0 to 100 Amps
Above 100 Amps
TOTAL
�'�
I hereby certi that I inspected the electrical installation described herein on the dates steted:
Irrigation B Rough In Date
Special Ins ' n�
Final Da :� -� y,�0�
Investigative Fee `�o
THIS INSTALLATIOPI MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
...».........,....._.........------ - -- --�-.».....- - ------
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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*08598054* °��`�3
PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes ❑ f76 Inspection Other Than Rough-In: L�Ready Now ❑ Will Call
�1�,4�� 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 Zp Code:
6719 KENNAST'�IV DR NE FRfDf.EY 66432
Section No. Township Name or No. Range No. Flre No. County�—�,.a
--°°-'-- -^'° --°-------- -------'--° I'Y�+R�
Occupant Phone No.
C.QPPE33 D L ------
POWeNSPer � Aa�ress
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ElecVical Contractor / Company Name Contractor License No. Master Lic. No. (Plant Elect. Only)
HUIVT ELEGTRi� GGRPQRATIUN CA 00883
Mailing Address (Contractor, Company or Owner Performing Installation)
23�10 TERRITC)RIAL ROAD , SAINT PAUL, MN 55114
Authorized Signature (Contractor, Company or Owner Pertorming Installation) Phone Number
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EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY