P - 82907•' REQUEST FOR ELECTRICAL INSPECTtON �
� � � � � � � � Minnesota State Board of Electricity
�r 1821 University Ave., Rm. S-f28, St. Paul, MN 55104 �
Phone (612) 642-0800 `�`
Home Duplex Apt. Bldg. Other: New Addn
Commercial industrial Farm Remod Re ir
Air Con X Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Ronge Elec. 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.
I�Gy �
17
Calculote Inspection Fee - This Inspection Request will not be accepied wifhout the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park StaA 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TQTAL
Sign/Outline Ltg. Xfmr. 15. 50
Alarm/Remote Conhol
Swimming Pool
I here certi that I ins fhe electrical installafion desaibed herein on the dafes sMted
Irrigation Boom ��9Mn Dafe
Special Inspectio '
Final 2 -i�
Investigotive Fee v
�THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� I���I OFFICE USE ONIY This request void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rou h-in ins �
6-1-98 9 P�on required$ ❑ Yes �] No inspecfion Other Thon RougMn: [$Ready Now ❑ Will Call
�You must call fhe inspector when ready� Dafe Ready:
I, � licensed conhactor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.�
4881 Main St NE c�N FRidley Z�P55421
Secfion No. Township Name or No. Range No. Fire No. CounN
Occupant
Matt Stene
Power Supplier
Phone No.
572-2111
Eleclrical Contractor (Company Name) Conhacror License No. Moster lic. No.
Total Electric Inc. CA02749
AAvilirig Address (Contracror or Owner Performirg Installafion)
1537 92 Ln NE Blaine Mn 55449
Authorized Sig (Contracror or Owner performing tallofion)
_ %"�. . h n t �� Phone No.
' � L �//ir '9`i'kL � �� � 786-8484
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY