P - 82200, 1'O 1�-454 []4 REQUEST FOR ELECTRICAL INSPECTION �E
Minnesota State Board of Electricity F. �
+� 1821 University Avenue Suite S-128. Saint Paul, Minnesota 55104-2993 --_ -
(651) 642-0800 www.elecfricity.state.mn.us ''�-'"
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Contlitioner 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 back of the white copy only.
NSP 3AVER'S SWITCH
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee.
�ther Installations Fee # Service Entrance Size Fee # Circuits / Feeders F�
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
TransformedGenerator INSPECTOR'S USE ONLY TOTif�esr
Sign / Outline Ltg. Xfmr. `"r°"
Alarm/Remote Control .
Swimming Pool
_ I herebvi certiN that I insoected the electrical installation described herein on Uie dates :
Investigative Fee �� /� � �_�/— ��
THIS INSTALLATION MAY BE ORDERED ECTED IF NOT COMPLETED IN 18 MONTHS,
_�.,2._s.,_.,,...w:.�..._,.�;�:....� •��:,�.y._.,..�._..�., .................................._...............................................................
I�IIIII ��I�� I���� I�I�� ��II� II� III� III) I�� OFFiCE USE ONLY Ttps request void 18 months fran validatbn date printed in this box.
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* 1 0 1 1 4 4* 3s'Cj �
PLEASE PRINT OR TY
Request Date Rough-In inspection required? 0 Yes p No Inspection Other Than Rough-In: � Ready Now 0 Will Call
�7�� You must call the inspector when ready! Date Ready:
I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Addr t, Box, t o Ciry ZP �de:
�`� ���� !� M ME FRiDLEY 55432
Section No. Township Name or No. Range No. Fire No. ____-___ Countyw „��A
---"'-- °---- °°___._"'_° --.- 111� IV1
Occupant BEGLAU DWIGHT P� �. _..__
Power $yqp�jer Address
i�r�r ------------
Electrical Contractor / Company Na e'• �� Contractor License No. Master Lic. No. (Plant Elect. Onty)
HUNT ELECTRIC CORPORATIQN CA 00�83
Mailing Address (Contractor, Company or Owner Performing Installallon1
2340 TERRITORIAL ROAD , SAINT RAUL, MN 56114
Authorized Signature (Contractor, Company or Owner Performing Ins 'on) Phone Number
l��iA�ft+E�� ( B5'� B46-28't ?
EB-OOOOtA-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY