P - 82079REQUEST FOR ELECTRICAL INSPECTION
iJ�-859'G7oV � Minnesota State Board of Electricity
1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
, (651) 642-0800 www.e/ectricity.state.mn.us '� - '
JC Home Duplex Apt. Bidg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Contlitioner Htg. Equip, Water Htr. Loatl 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.
Calculate
Mobile Home Park Stall
Street Ltg./ Traffic Sig.
TransformedGenerator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irri ation Boom
Fee -
N3P SAVER'S 3WITCH
wil/ not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
�ted without ihe correct fee.
# Circuits / Feeders
0 to 100 Amps
Above 100 Amp.
TOTAL���„
I insoected the electrical installation described herein on the dates stated:
g Rough In Date
Speciat Inspecti Y" ,<
Investigative Fee F�ei � Date2 � Z_ G �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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OFFlCE USE ONLY This request void 18 moMhs from validation date printed in ihis box.
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PLEASE PRINT OR TYPE
Request Da4e Rough-In inspection required? ❑ Yes ❑ Na Inspection Other Than Rough-In: eady Now ❑�II 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 Zip Code:
6545 Mt71VROE ST NE FRID�EY 55432
Section No. Township Name or No. Range No. Fire No. County
------._. _...� -------------- -------- /'Y�VRO
OccupaM Phone No.
WENDT LEE H ---
Power Supplier Address
. NSP � L.� � ___.._._...
Electrical Contractor / Company Name Contractor License Na. Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor, Company or Owner Performing Installation)
2300 TERRITC}RI�►L ROAD , SAINT PAUL, MN 56114
Authorized Signature (Contrador, Company or Owner Perfortning`Installatlon) Phone Number
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EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF VELLOW COPY