P - 83173REf�UEST FOR ELECTRICAL INSPECTION
..? L� L- 2 2 8 Min�esota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remoc
Air Cond. Htg. Equip. Water Hfr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on fhe bock of the white copy
Update wiring to code
Calculate Inspection Fee - This Inspection Request w'iil not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/FeedE
Mobile Home Park Stall 0 io 200 Amps 0 ro 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100
Transformer/Generator INSPECTOR�S USE ONLY � TC
Sign/Oudine Ltg. Xfmr. �� � �_ ,�" �!% �"'� �� f���t
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x �.�` � :
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Fee
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A arm/Remote Conho I�
Swimming Pool � h �eyJt�hat�� -� e�1ical i�talla�on described he n ony tl�dares�ia�edG
Irriqation Boom a,„,,,tii„ pare
Investigative FedG� V V e� j� 1
THIS INSTALLATION MAY BE ORDERED ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
9 8 � 4 1$ OFFICE I�E ONLY This requesf void I S months irom wlidalion dafe printed in this box.
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* O 5 6 G� C� �$%* PLEASE PRINT OR TYPE
Req�est Date Rougfti� inspeclion required@ ❑ Yes ❑ No Inspection Other Than RougMn: ❑ Ready Now � Will Call
5 4 9$ (You must call the inspec�or when readyJ Date Ready:
I, (�lice�sed conhactor ❑ owner hereby request inspecfion oF the above elecirical work at:
Job Address (S1reet, Box, w Route No.) City Zip Coda
5422 Madison St NE Fridle 55421
Section No. Township Name or No. Range No. Fire No. Co�ny
Occupant
�arol Johnson
r�. s����.
Elecirical Conhactor �Company Name) Confracfor
American Eagle Electric, Inc Ci
Mailing Address (Cnntracb: w Owner Performi� Installo�ion)
Phone No.
572-9221
Master Lic.
18475 Rum River Blvd NW, Anoka, MN 55303
Authorized Signature (Conhacfor or Owner Performirg InsfallaHon� � � p�e p�_
2��`��) 753-0438
B OOOOI A-11 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON 6ACK OF YELLOW COPY