P - 822421,, �fl 15-274
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� REQUEST FOR ELECTRICAL INSPECTION �"�° '
Minnesota State Board of Electricity
1821 University Avenue Saite 5-128, Saint Paul, Minnesota 55104-2993 =
(651) 642-0800 www.electricity.state.mn.us
Home Duplex Apt. Bidg. 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. Enter remarks in this space and on the back of the white copy onty.
NSP SAYER'S SWITCH
Calcu/ate Inspection Fee - This Inspection Request will not be accepted without the correct fee.
Installations Fee # Service Entrance Size Fee # Circuits / Feeders
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irriqation Boom n ..
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
0 to 100 Amps
Above 100 Amps
TQ�@y.50
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I herebvi certiN that I insoected the electrical installation described herein on the dates statetl:
Special InspectidM �
Investigative Fee F�� D�i� 30 —o`�
THIS INSTALLATION MAY BE ORDERED ONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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I tllllt ��I�) �II�� �III) ���II II I�I�I� ���) I�I OFFICE USE �1LY This requesl vad 18 months from validation date printed in this box.
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PLEASE PRINT OR E
Request Date Rough-In inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
� 14i�y You must calt the inspecror when ready! Date Ready:
I, [�ticensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address Street, REC31S DF� NE °�Rt�� Zp Co=r��
W�rG
Section No. Township Name or No. . Range No. Fire No. CousM_��u_�
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Occupant NEt.SON GiiETCHEN M Phone No.
Power�S4pp�r Address
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Electrical Contractar / Co a : Contrector License No. Master Lic. No. (Plant Elect. Only)
HUNT ELECTRIC TION CA 00883
Mailing Address Contractor, Com an or Owner Perfortning Installation)
2300 RRITOI�U�L RO/4Q , SAINT PAUL, MN 56114
Authorize gnatur o ractor, Company or Owner Performing Installation) Phone Number
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EB-00001A-12 5/1999 STATE BOAqD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY