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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity -
1827 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 =_
(651) 642-0800 www.e/ectricity.stafe.mn.us
Home Duplex Apt. Bidg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr, Loatl Mgmt, Other:
Dryer Range Elect. Heat Temp. Service
X" above the work covered by this requesG Enter remarks rn this space and on the back of the white copy onty.
N3P 3AVER'S 3WCrCH
Calcu/ate lnspectic
Jther Installations
Mobile Home Park Stall
Street Ltg, / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irri ation �oom
Fee - This
�e #
will nof be accevied without the correct fee.
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
#
0 to 100 Amps
Above 100 Amps
TO�..aa„
.*,'�"`�� e
g Rough In Date
Speciallnspecti ( '
Investigative Fee Final Date _�� _ �
THIS INSTALLATION MAY BE ORDERED NEC1'ED IF NOT COMPLETED WITHIN 18 MONTHS.
..-..-_� _-.....,..,�_,....�..._._,_� �.._._.__ ................. ..... .......... . ........................................... .........--�---�--._.___.._..._...........,..�..o..,....�,.....,,..
OFFICE USE ONLY This request wid 18 months from valitlation date printed in this box.
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PLEASE PRINT OR TY
Request Date pough-in inspection required? � Yes � No InspecGon Other Than Rough-In: Reatly Now � Will Call
� ���� You must call the inspector when readyl Date Ready:
I, �j licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address Street, Box, or Ro�te No.) City Z�P C�e�
324 OS�RNE RD NE �RID�EY 5543,'t
Section No. Township Name or No._W.F---�_ Range No. Fire No. CounryAav„ti�d
MVIV'1
Occupant �� GREGaRY T Phone No. �
Power ier Atldress
Electrical Contraaor 1 Company Name CoMractor License No. Master Lic. No. (PIaM Elect. Onry)
HUNT ELEGIRI� CORP�4RAT10N GA 04883
Mafling Address (Contrador, Company or Owner Performing Installation)
2300 TERRtT�DRiAL ROAD , SAINT PAUL, MN 56'114
Authorized Signature (Cont r, r ner Performing Ins I'on) Phone Number
J��+A� � �'� SA�2911
EB-OOOOtA-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY