P - 8387340���322 �
REGIUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
� Home Duplex Apt. Bldg. Other:
Commercial Industrial Farm
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on
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New
Remod
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of the white copy only.
Calculate Inspection Fee - This Inspection Reqvest will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amp:
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control �
I hereby certify fhaf I inspecfed ihe electrical insfallation dexribed herein on the dafes stated
Rouoh-In Dafe .
Fee
15.50
Special Inspeal�rJ `
Investigative Fee F��al /
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 AAONTHS.
OFFICE USE ONLY This request void 18 monihs from validation date printed in this box.
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* � 4 � 5 3 2 2 9* PLEASE PRINT OR TYPE l� '��
Request Date Rough-in inspection required? ❑ Yes � No Inspection Ofher Than Rough-In: 7❑ Ready Now ❑ Will Call
1 �-8� 9 7 (You musf call fhe inspecfor when ready� Dafe Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sfreet, Box, or Route No.) City Zip Code
54 Locke Lake Rd Fridley 55432
Section No. Township Name or No. Range No. Fire No. County .
Anoka
Occupant Phone No.
Blaine Jones 574-1180
NSP North Div. 3115 Centre Point Dr Roseville MN 55113
Elec}rical Confractor (Company Name) Conhacfor License No. Master Lic. No. (Planf Elecf. Only�
Total Electric Inc. CA02749
Mailing Address (Conhactor or Owner Performing Installation)
1537 92nd LN NE Blaine MN 55449 ,".�„_
Authorized 5 afure Confracror or Owner Perfor Ins Ilafion � �'"' '-'� ` Phone No.
( � . �..�� �'* ."G�!.� : t
. �°` 786-8484
:8-00001 8/ 6 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY