P - 81152.
, 0-858-291 []8
E
REQUEST 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
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 Temp. Service
X" above the work covered by this request. Enter remarks in this space and on the back ot tne wnite copy onry.
NSP SAVER'3 3WCTCH
Ca/cWate Inspectii
�ther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimmina Pool
Fee - This Inspection Request wil/ not be accepted without the correct fee.
;e # Service Entrance Size Fee # Circuits / Feeders I
0 to 200 Amps 0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TO�L�,
J�v�,r
I hereby certify that 1 ins ected the electrical installaNan described herein on the dates
Rouab In Date
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Inve&tigative Fee r� ��% � b� 2"`{'��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLE7ED WITHIN 18 MONTHS.
� Y,�.�v. V. V. �`� H.. �'.WM �.y N�-�✓�^ OFFICE USE ONLY This request void 18 moMhs from validation date printed in this box.
I Illill IIIII Illll Illil Iillt NII!�""�II IIII IIII � aG ��
*08582918*
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Request Da[e Rough-In inspection required? Q Yes O No Inspection Other Than Rough-In: IJ Heady Now � WiN CaN
��i��� You must call the inspecfor when ready! Date Reatly:
!
I, �j licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at;
Job Acldress (Street, Box, or Route No.) CHy Z�P C��
464 L4N�FEt�Od61 ST ME FRID�EY 5643Z
Seclion No. Township Name or No..w.�Yµ Range No. Fire No„.�_ CounryA���
/'11�Yi11't .
Occupant ERIGK�C?td AI.ViNA M Phorre No. �.
Power er Address
� .---.�...._
Etectrical Contracror / Company Name CoMractor License No. Master Lic, No. (PIaM Elect. Only)
HUNT ELEGTRiC GDRP�RATION CA �3
Mailing Address (Contractor, Company or Owner Parforming Installatioo)
Z300 TERRIT+dRWI RQAD , SA�NT PAUL, MN 56'11�1
Authorizetl Signat�(E�Vt�j;c�r,;C�any or Owner Pertorming`Ins I ion) Phone Number
V � J��� \ � U �'�'i 9
EB-00001A-12 5/1983 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY