P - 82444REQUEST FOR ELECTRICAL INSPECTION ��
' U°� ���- 6 2 3� Minnesota State Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us "�'
Home Duplex Apt. Bldg. Other: New Addn
mmercial Industrial Farm Remod Repair
Air Conditioner Hig. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back�of the white copy only.
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Calculate Inspection Fee - This Inspechon Requesi wiN n e accepted without the correct fee:
Other Installafions Fee # Service Enhance Size # Circuifs / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / TraFfic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL �
Sign / Outline Ltg. Xfmr. �
Alarm/Remote Control �� t� �
Swimming Pool ��
I hereb ceA'i ihat I ins ted the elechical insfallation described herein on the dates sfated:
Irrigation Boom Rough-In Dare
Special Inspection
Final �a ��
Investigative Fee '" �
THIS INSTALLATION MAY BE ORDERED DISC NNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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� PLEASE PRINT OR TYPE
Requesf Date Rough-in inspecfion required? ❑ Yes o Inspection Other Than RougMn: ❑ Ready Now Will Call
9-15-00 You must call the inspector when ready Date Ready:
I, �icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sfreef, Box, or Roufe No.) Cily Zip Code
Rice Creek Blvd Fridle 55432
Secfion No. Township Name or No. Range No. Fire No. County
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Occupant Phone No.
Todd Johnson 571-5358
Power Supplier Address ��
Connexus Energy PO Box 279 Ramsey MN 55303 323-2600
Electrical Conhactor / Company Name Confracfor License No. Masfer Lic. No. (Plant Elecf. Only)
Total Electric Inc. CA02749
Mailing Address (Conhacfor, Company or Owner Performing Installation� �
10760 ankato ST S' e 1 Blaine MN 55449
Aufhorized i afur (Conhacfor Com � y or n e min tallation) Phone Number
(76� 786-84�4
EB-0000 2 5/1999 STATE BOARD COPY . SEE INSTRUCTIONS ON BACK OF YELLOW COPY