P - 82661REQUEST FOR ELECTRICAL INSPE:CTION
4'!. p/� Minnesota State Board of Electricity
. �`i� � 9 5 9 1821 University Ave., Rm. S-128, St. Paul, PAN 55104
Phone 612 642-0800 mt�
' � � CITY ��,�
Home Duplex Apt. Bldg. Other: New Addn
X Commercial Indushial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. �nter remarks in this space and on the back of t�ie white copy only.
T8268 - REWORK/INSTALL FOR DAMAGED FEEDER.
Calculate Inspection Fee - This
Other
Mobile Home Pork Stall
Street Ltg./Traffic Sig.
Tra nsformer/Generator
Sign/Outline Ltg. Xfmr.
Alarm/Remote Conhol
Swimming Pool
Irrigation Boom
Special Insp
vspection Request will noi be accepted withoui the correci fee
Fee # Service Entrance Size Fee # Circuit �/Feeders Fee
0 to 200 Amps 0 to 100 �,mps
Above 200 Amps Above 10(� Amps
INSPECTOR'S USE ONLY TOTAL
20.50
thar I
the electrical installafion described hereir on the dates stated
�ar�
Final ' ' Dat
Investigative ee �>�_ �-- i � 7 � �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONIY This request voio 18 months from v ilidation date printed in this box.
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* � 4 �+ 4 9 5 9 7* PLEASE PRINT OR TYPf:
Request Date Rough-in inspecfion required? ❑ Yes [� No Ins fion Other Than Rou h-I �:
p� g ❑ Ready Now � Will Call
12 / 12 / 96 �You musf co�� ti�z inspecfor when reotiy) ^ Date Ready:
I, `� licensed cont�actor ❑ owner hereby request inspection of the above electrical work ai:
Job Address (St eet, Box, or Ro�te No.) C�ry, '
5 MAIN STREET FRIDLEY
Sechon No. Township Name or No. Range No. Fire No. County
'��� �' ANOKA
Occupant Phone No.
MCGLYNNS DECO PACK
Power Supplier Address
NSP
Electrical Conhactor �Company Name� Conhador License No.
MUSKA ELECTIC COMPANY CA01287
55421
Mas er Lic. No.
Mailing Address (Conhacto� or Owner Performing InsTallation� -
1985 OAKCREST AVENUE ROSEVILLE, MN 55113
Aufhoriz i fur (Conhado r PerFo ' Installation Q C� Phor e
- . .i � OV 6:3
OlA-11 8/96 STATE RD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY