P - 82201. 1=011-456 09
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REQUEST FOR ELECTRICAL INSPECTION �`� Eh
Minnesota State Board of Electriciry Fs- _
1821 Universily Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 -- _
(651) 642-0800 www.electricity.state.mn.us :--
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
X" above the work covered 6y this request. Enter remarks in this space and on the back of the white copy only.
N3P SAVER'S 3WITGk
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee.
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransformedGenerator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Po I
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
0 to 100 Amps
Above 100 Amps
TOT��-
I hereby certify that I ins cted the electrical installation described herein on ihe dates stated:
Irrigation Boo Raugh In Date
Special Inspection
Investigative Fee � �a�'% � /— O-C�
THIS INSTALLATION MAY BE ORDERED NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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OFFICE USE ONLY This request w�l 18 monlhs from validation date printed in ihis box.
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PLEASE PRINT OR TY
Request Date ` Rough-In inspection required? ❑ Yes ❑ No Inspection Other Than Rough-Irr. � Ready Now ❑ Will Call
�27�� ' You must call the inspector when ready! Date Ready:
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I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Addr74 t�aet, Box, o�����Y DR NE c�� FRIDLEY zp ca543't
Section No. Township Name or No. Range No. Fire No. Countys„��A
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Occupant FITZGERALD MIGHAEL Ph°"e "°. — —
Power�pp�{pr Address
IV�1'' -----°-°
28Q�
Electrical Contractor / Company Name Contractor License No. Master Lic. No. (Plant Elect. Only)
HUNT ELECTRIC CORPORATtON GA 00883
Mailing Address (Contractor, Com any or Owner Performin Installation
230D TERRITUR�AI. ROAD , SAN�1lT PAU�, MN 55114
Authorized Signature (Contractor, Company or Owner Performing In 'on) Phone Number
J�� ( 65'� 646-25??
EB-00001A-12 5/1999 S7ATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY