P - 81071' � REQUEST FOR ELECTRICAL INSPECTlON
� �-859-658 �7 Minnesota State Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us r°
Home Duplex Apt. Bltlg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Loatl Mgmt. Other:
Dryer Range Elect. Heat 7emp. Service
X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
NSP 3AVER'3 3WITCH
Calcu/ate Inspection Fee - 71his Inspection Request will not be accepted without
InstallaHons Fee # Service Entrance Size Fee # Circuits /
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Poo�
Irrigation Boom
SD@CI81 If1SD2Ctl
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
Rouph In
0 to 100 Amps
Above 100 Amps
Date
� I Investigative Fee � � � � (�i—" •4 ?f"�TjP
THIS INSTALLATION MAY BE ORDERED DI ONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFRCE USE ONLY This request vdd 18 months from validation date printed in this box.
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*08596587* ���
PLEASE PRINT OR TY
Request Date
Rough-In inspection required? � Yes � No Inspection Other Than Rough-In: Ready Now � Will Calt
� y�� You must call the inspector when readyl Date Ready:
I, �] licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address Street, Box, or Route No.) Ciry Z�P C�e�
?18 KfMBAL� ST NE FRIDLEY 56�43�
Section No. Township Name or No. Range No. Fire No...N� County��
Occupant �AY DANIEL C Phone No. �_N
Power �ypgier Address
i��sF� ------°-�'
Electrical CoMractor / Comparry Name Contractor License Na. Mas[er Lic. No. (Plant Elect. Onty)
HUiVT ELECTRtC GGRPORATION CA OD8�3
Mailing Address (Contrector, Company or Owner Performing InstaBation)
2300 TERRITORIAL ROAD , SAINT PAUL, MN 551'1A
Authorized Signature (Contractor, Company or Owner Performing 1 'on) Phone Number
r. r J��iC�Klr ( �9) 646-2891
EB-00001A-12 5/1999 D COPY SEE INSTRUCTlONS ON BACK OF YELLOW COPY