P - 82241� • 1� -015-266 0
i
REQUEST FOR ELECTRICAL INSPECTION �` °
Minnesota State Board of Electricity
1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.e/ectricity.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 ihe white copy on/y.
fVSP �AYER'S SWITCN
Ca/culate Inspecti<
�ther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Si�.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irrigation Boom
Speciallnspecti �
Fee - This Inspection Request wiii not be accepted without the correct fee.
�e # Service Entrance Size Fee # Circuits / Feeders
0 to 200 Amps 0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TOTAL
�.�
I hereby certi that I ins ected the electrical installation described herein on the date
Rough In Date
Investigative Fee rm� � � � I f/ 2��8 � I
THIS INSTALLATION MAY BE ORDERED DI NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
..�:........,.w.�_,�j.�..._,.v..�...........,,�,..-,._.,.-.,.,_._.-..-,_.,,,.._._.. ....-• - - ................... ... ..,...,.. -
. _.� . . ..........._. ,_ _ s ........... .. ,.
I IIIIII IIIII IIII� IIII� �IIII III IIIII IIII I� OFFICE UfE ONLY This requeat void 18 marths from validation date printed in ihis box.
• `-� �
*10152 8* ����
PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes ❑ NO` Inspection Other Than Rough-In: ClReady Now ❑ Will Call
J 4��lfyY\ You must call the inspector when ready! Date Ready:
i �+v�
I, [�Qicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) Ciry �P C�de�
68t1 MAQtSON ST NE FRfDtEY 5643�2
Section No. Township Name or No. Range No. Fire No. CouMy
• /'YR/M
Occupant Phone No.
LENNdX MEUNDA A
Power Supplier Address
NSP 8,� Q
Electrical Contractor / Company Name Contractor License No. Master Lic. No. (Plant Elect. Only)
HUNT ELECTRiC CGRPORATION CA 00983
Mailing Address (Contractor, Company or Owner Performing Installation)
2300 TERitROR1Al RQAD � SAINT PAUL, MN 661i4
Authorized Signature (Contrector, Company or Owner Perfarming Installation) Phone Number
�
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY