P - 81139!
, � 0-858-307 �]2
REQUEST FOR ELECTRICAL INSPECTION �''
Minnesota State Board of Electriciry - �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 -_ _
(651) 642-0800 www.e/ectricity.state.mn.us
Home Duplex Apt. Bldg. 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 on/y.
NSP 3AVER'S BWITCH
Calculate
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irrigation Boom
Special Inspec on (
Fee -
will not be
# Service Entrance Size
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
In
without the correct fee.
�ircuits ! Feeders
0 to 100 Amps
Above 100 Amps
TO�
n described herein on the dat
Date
I � Investigative Fee � �- �� �- J �o-o/ �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
. mT��.OFFICE OSE ONLY This request void 18 months from validation date printed in this box. ������
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*08583072* ��
PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes ❑ o Inspection Other Than Rough-In: eady Now � Will Call
� ���� You must call the inspector when ready! Date Ready:
I, �] licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) Ciry Z�P ��
6472 RNERVtEW TER NE U FRIQLEY 56437
Sectlon No. Township Name or No.�_Y� Range No. Fire No�—� County��w
t��
Occupant �L� R��Y , Phone No. �-
Power`�S�pier Address -_��
1+1 P
Electrical Contractor / Company Name Contractor License No. Master Lic. No. (Plant Elect. Only)
HUIVT ELEGTRIC CORP4RATION CA 00883
Mailing Address (Contractor, Company or Owner Pertorming Installation)
2300 TERR ROAD , SAINT PAUL, MN 5611�
Authorized Signature (Contr o, y�l Owner Performing Ins I'on) Phone Number
��,�qK ( �'i'� 848-2819
EB-OOOOtA-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY