P - 83584REQUEST FOR ELECTRICAL INSPECTION
/��� 9 2 6� Minnesota State Board of Electricity �
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
C I T Y Phone (612) 642-0800 �� � ����
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod X Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. $ervice
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
T5082 - INSTALL 200' 100A FEEDER & SUBPANEL, WIRING
FOR PARTITION, WIRING FOR 13 ELEC. BASEB�ARD HEATERS,
INSTALL BASEBOARD HEATERS.
Calculate lnspection fee - This Inspection Requesl wil! not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park $tall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY � TOTAL 6 5. 5 �
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control �
Swimming Pool
I here certi that I ins the elechical inslalla6on described herein on the dates staled
Irrigation Boom Ra�Mn Dore
Special !ns
Investigative F�� �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED W HI 1N 8 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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* 0 7 3 1 9 2 6 2* ���d
PLEASE PRINT OR TYPE
Requesf Dote Rough-in inspection requiredi ❑ Yes �] No Inspection Other Than RougMn: ❑ Ready Now � Will Call
1/ 4/ 9 9 (You must call 1F�e inspedw when ready� Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sheef, Box, or Roule No.) City Zip Code
5735 MAIN STREET FRIDLEY 55421
Section No. Township Name or No. Range No. fire No. Counfy
ANOKA
Occupanf phone No.
MCGLYNN DECO PAK
Powe� Supplier Address
ANOKA
Elechical Contractor �Company Nome) Conhac�or License No. Master Lic. No. (Plant Elect. Only)
MUSKA ELEC. CQ. CA01287
Mailing Address �Coohacior or Owner Performin lostallation
19$5 KCREST AV�. � EVILLE, MN 55113
Authori Sign e � aclor or � r mg I Ilatio �- Phone No.
- 636-5820
E 00 A-11 8/96 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY