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*0367'S279*
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
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, Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat emp. Service I
°X° above the work covered by this request. Enter remarks in this space and on the back of ihe white copy only. I
Calculate Inspection Fee - This Inspection Request will not be accepted without the conect fee: '
Other Fee # Servicefntranc ize Fee # Circuits/Feeders Fee
Mobile Home Park Stall � 0 to 0 Amps 8 0 to 100 Amps :�
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. �
Alarm/Remote Control � 6,S'��
Swimming Pool I hereby certify that I inspec d the electrical installation described herein on th� d3tes stated
Irrigation Boom Rough-In oat
Special Inspec � ' `
Investigative F � Final eO'� _�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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f OFFICE USE ONLY This request void 18 months from validation date printed in this box.
{ �367-527 a 93
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PLEASE PRINT OR TYPE � �
Reqn s�Dlat� /� 7 Rough-in inspection required? �}l'es ❑ No Inspection Other Than Rough-In: ❑ Ready Now� Will Call
7 (You must call the inspector when ready) Date Ready:
I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at:
J�7�d�re�s (�}reet, Box, or Rpute NoJ City F r i d 1 e y Zip Code
/ z5 l�yric Ln
Section No. Township Name or No. Range No. Fire No. County A n O k a ��.
i
Occupant Phone No. '�.
Les Kuizanen i,
�°"'A �°� a C o- o p �dress
Electrical Contractor (Com any Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
Bassing �lectric, Inc. CA00237 I
Mailing Address (Contractor or Owner Performing Installation)
1354 McKay Dr NE Ham Lake
Authorized Sig ture (Contractor or Owner Performing Installation) . ��� Phone�,� 4- 3 2 9 8
EB-00001A-11 S/95 STA OARD COPY - SEE INSTRUCTIONS ON BACK OF VELLOW COPY