P - 80003REQUEST FOR ELECTRICAL INSPECTION
` Minnesota Board of Electricity � .
1-396-165 1❑ iB21 University Avenue Suite S-128, Saint Paul, Minnesota 55104 — :'
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electriciry. sta te. mn. us
Identify the work covered by this request:
qMIEW ❑ REMQDEL ❑ ADDITION 0 REPAIR
�
Above 200 Am ere � $10
ALARM, COMMUNICATfON, F;EMOTE CONTROL, SIGNALING
3 to 12
0
ta
�NE & TWO FAMIIY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit Q$E
Additional Insoection Trips � $2Q
FOR INSPECTOR USE ONLV
FOUGH IN
FINAI. INSPECTION
TOTAL FEE I �'�I
d fee is 5201
installation described herein on the dates sta[ed:
DATE
G-�6 - 63 I
FOR OFFICE USE ONLY
IIII1lI�Ni� I II lil! I�I I
I�I�ilflfll��l� �
* 1 3 9 6 1 6 5 1" �`15 ap.S�
Requea8Dn�2 Rough-in Inspection Required? ❑ Yes XNo Inspection Other Than Rough-in: �j Ready Now ❑�II Call
You must call the inspector when readyl Date Ready: X
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical wo�C at:
Job Address (Street, Box, or Route No.) City Z�p Code
1392 f7S8t7RNE Ra NE FRIDLEY 55�32
Section Township Range Fire No. Counry a�iA
occupanPFiAPI HUC)FIO N 2 9� 7 G Phone
Power Supplier Address
�L �Y
Electrical Contractor / Company Name Contractor License Number Master License Numbe�
HUNT EI_EGTRIC CORP4RATION GA 00883
Mailing Address (Contractor, Company or Owner Performing Installation)
2300 TE'ii�ITC7F2iAL i�AD , SAiNT PAUL, MN 55114
Authorized Signature (Contractor, Company or Owner Perfortning Installation) Phone
$51 646-2911
EB-OOOOtA-13 7f1f2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY