P - 81145' REQUEST FOR ELECTRICAL INSPECTION e` °`
.�-858-299 1❑ Minnesota State Board of Electricity -_ _
1821 University 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 Repair
Air Conditioner 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 the white copy on/y.
N3P 3AVER'3 3WITCH
Calculate Inspectic
Jther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimmina Pool
Fee - This
not be accepted without the correct fee.
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I hereby certity that I inspected the
Rough In
0 to 100 Amps
Above 100 Amps
TO'f��..
jnarv�r
Date
� � Investigative Fee � � � _,��� �-�, � �� �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.�
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OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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*08582991* ���
Request Date ^
��/7�� Rough-In inspedian requiretl? ❑ Yes � No Inspection Other Than Rough-In: Ready Now ❑ Will Call
You must call the inspector when ready! Date Ready:
I, �] licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address Street, Box, or Route No. City Z�P �e�
7� I�tEM41�Y LN NE FRIDLEY 56d�t
Section-No. Township Name or No._��� Range No. Fire No� County� .
Occupant RODGERS RQLLAhID LUTFIER Phone No. _____,
Power ier Address
Elecfical CoMractor / Comparry Name Contractor License No. Master Lic. No. (PIaM Elect: Only)
HUNT ELECTRIC C4RPORATiQN CA OQ8�3
Mailing Address (Contractor, Company or Owner PeAorming Installation)
23QQ TERRIiOR1A� ROAD , SAINT RAUL, MN 65114
Authorized Signature ( r an�% or Owner Perfortning Ins I'on) Phone Number
� J�:�it�Ir� ( 651) 646-29't 7
EB-00001A-12 5/7999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY