P - 81923REQUEST FOR ELECTRICAL INSPECTION
.V J J- 9 31 � Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
Phone(612)642-0800
X Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Wafer Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above Ihe work covered by this requesi. Enter remarks in this 3pace�and on the back of ihe white copy only.
reconnect furnace & A/C
Calculate Inspecfion Fee - This Inspection Request will not be accepted wiihout the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sfreet Ltg./Troffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generotor INSPECTOR'S USE ONLY TO AL QI(�
Sinn/nuflinc. I M �r�i !l h �� O �"
Swimming Pool
I hereb certi thaf I ins ted 1he electrical installation described herein on the dc
Irrigation Boom RousaMn Date
� Investigative Fee � � ( ��'j -�— t!�
THlS INSTALLATlON MAY BE ORDERED DIS ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validafion date prinfed in this box.
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* 0 8 3 9 9 3 1 3* p20-�'�
PLEASE PRINT OR TYPE
Requesf GDate Rougirin inspecfion required2 ❑ Yes � No Inspect:on Other Than Rou h-In: �q Ready Now �] Will Call
0 V���� O� �You must call ihe inspectw when ready) oo,e Reody: 0 6- I 9- O 1
I, [�licensed contractor ❑ owner hereby request inspection of the above electrical work at:
lob Addreu (Sfreet, BcY �r Roule No.� City Zip Code
1500. Innsbruck No. Dr. Fridley 55432
Secfion No. Township Name or No. Range No. Fire No. Counfy
��U`��� Robert Kutch r� IPh�(763)574-1500
xcel energy
Conhacror �Company Name) Contracror License No. Master Lic. No. (Plant Elect. Only)
Brandon Electri.c Inc. CA00307
�ddreu (Contraclor or Owner Performing Installafion)
7701 Colfax Ave. N. Brou)�lyn Park, MN 55444
i natura (Conhacfor or Owner Performing Installafion) Phone No.
� ` . (763)560-5311
4-1 1 8/96 �p� gOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY