P - 81281REQUEST FOR ELECTRICAL INSPECTION �
1�� - 9 3 8� Minnesota State Board of Electricity
1821 University Ave., Rm. 5-128, SL Paul, MN 55104
- Phone (612) 642-0800
J .
Home Duplex Apt. Bldq. Othec New Addn
Commerciol Indusfriol Farm
Air Cond. Htg. Equip. Woter Hh. Load Mgmt. Olher
Dryer Range E�ec. Heat Temp. Service
"X" obove the work covered by this requesf. Enter remarks in fhis space and on the back of fF
Generator panel and adder box
G�
Calwlate inspec�ion Fee - 7his (nspecfion Request will not be a<cepled wi�houf the wrrecf fee:
Other Fee R Service Enhance Size Fee R Circuits
Mobile Home Park Stall 0 �0 200 Amps �0 100 A
Sfreet lfg./TraHic Sig. Above 200_Amps Above 100
Tmnsiormer/Genemtor INSPECTOWS USE ONLY
�he e�ecv�ca�
whife copy only.
eedere Fee
ps OS
_ Amps
TOTAL 15.50
Imestigalive Fee � - '� z "' �C� �-- � � Z ��
THIS INSTALLpT10N MAY BE ORDERED DISCONNECTED IF NOT COMP�ETED WITHIN 18 MONTFIS.
OFFIGE USE ONLY Thls reqoasf void 78 monihs hom validotion dale prinled in ihls 6ox.
��u� ���i � ������� �� �� �� ��������n • �s �
* 0 7 3 7 9 3 8 1* a6�1�
PLEASE PRINT OR TYPE
Request Date Roughin inspxtion required? ❑ Yes �No Inspecnon Other Than Roughin� �Ready Now � Will Coll
4-19-99 Iro� m�,i �ao �na ��.�ao� w�� ,�dyl oar� aeaay�.
I, � licensed contro<tor ❑ owner hereby reques� inspection of the above electrical work at:
lob Address �S�ree�, Box, w Rouk Na.) Ciy Zip Code
5206 Pierce St NE Fridley 55421
Sx��o� No. townshio Nome or No. Ranqe No. F�e No. Counrv
I Occupont
Don Fulcher
Total Electric Inc.
lail��g Address �Canrcacror or Ow�er Performin
107fa0 Mankato St NE
CA027
MN 55
Phone No.
571-7692
i� � - i
STAiE 60AHO COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
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