P - 82204-�p REQUEST FOR ELECTRICAL INSPECTION �` E
—V ��-458 5[� Minnesota State Board of Electricity
' 1821 Universiry 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 By this request. tnter remarks �n tn�s space ana on rne vacK or rne wnire copy on�y.
NSP SAVER'3 SWlTCH
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outiine Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irrigation �qpp� ,� _
Fee - This Inspection Reauest will not be accepted without the correct fee.
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
1 herebvi certiiv that I insoected the electrical
0 to 100 Amps
Above 100 Amps
To��S7�
�n described herein on the dates stated:
Date
I nvestigative Fee �'"� ��/�c-,.—*, I oac� r 2,r ' a� I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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OFRCE USE ONLY TMs requeM void 18 rtwnihs from validation date printed in this box.
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*101 14 5* � ��`j
PLEASE PRINT OR TY
Re uest Date Rough-In inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
�Z��� � You must call the inspector when ready! Date Ready:
I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Addre�,S,(yS�eet, Box, ���L�N G�R � °iry f RIDl.EY ZIP �
;�a
Section No. Township Name or No. »»��M Range No. Fire No. � County���
Occupant KELLER SHAREN M Ph°"e "°. ----__
Power $��er Address
� � � � � � ------------
Electrical Contractor / Company Name Contractor License No. Master Lic. No. (Plant Elect. Onty)
HUNT ELECTRtC C4RPORATtON CA 00883
Mailing Address (Contractor, Company or Owner Performing Installation)
2300 TERRITORIAL ROAD , SAINT RAUL, MN 55114
Authorized Signature (Contredor, Company or Owner Performing In a'on) Phone Number
J�iE� ( �'� B46-2S't 4
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YEILOW COPY