P - 82976l REQUEST FOR ELECTRICAL INSPECTION
5 2 0- 015 Minnesota State Board of Electricity
i821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: X New
Commercial Industrial Farm Remod
Air Cond. Htg. Equip. Water Htr. Load Mgmt. pther:
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
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Pee # Service Entrance Size' --Fee # Circuits/Feed�
Mobile Home Pork Stall 0 to 200 Amps 0 ro 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100
Transformer/Generator INSPECTOR'S USE ONLY T(
line Ltg. Xfmr.
mote Confrol
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Fee
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 1 s from validation date printed in this box.
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* d 5 2 � � 1 5 9 * PLEASE PRINT OR TYPE
Requesf Dofe Ro Irin ins on r uired$ ❑ Yes
ug pecli eq � No Inspeclion Olher Than RougMn: � Ready Now � Will Call
3-1 1— 9 H � �You must call the inspector when ready) Da�e Ready:
I, � licensed controctor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Rou�e No.) Ciy Zip Code
7921 Riverview Terrace Fridley 55432
Secfion No. Township Name or No. Range No. Fire No. County
Anoka
Occupant Phone No.
Joel Ma.rquardt 786-0808
Power Supplier Addreu �
Elechical Contracror (Company Name� Controc�or ticense No. A�er lic. No. rPlant Elxl. Only�
Total Electric Inc CA02749
Mailing Addreu (Conhaclor or Owner PerForming Installation)
1537 92nd Ln NE Blaine MN 55449
Authwized Sig re (Contractor or Owner Performingin Ilafion) � Phone No. �
/� � 786-8484
E�00001 1 8/96 S7AT� gOARD COPY - SEE I ACK OF YELLOW COPY