P - 81066REQUEST FOR ELECTRICAL INSPECTION � E
, 0-859—V�7 a Minnesota State Board of Electriciry
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us : —`
Home Dupiex Apt. Bldg. Other: New Addn
Commercial Intlustrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
X" above the work covered 6y this request. Enter remarks in this space and on the back of the white copy on/y.
NSP SAVER'3 SWITCH
Calculate Inspection Fee - This Inspection Request will not be accepted without the
nstallations Fee # Service Entrance Size Fee # Circuits / Fee
Mobile Home Park Stall
Street Ltg./ Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irrigation Boom �+ ,
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I herebvi certiN that I
0 to 100 Amps
Above 100 Amps
TO_�n
--.�.��0
installation described herein on the dates s
Investigative Fee Finai � � I �� ,x �^ °'�-.--�
THIS INSTALLATION MAY BE ORDERED DI ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� �T���������'�� OFFICE USE ONLY Thie request void 18 months from validation date printed in this box.
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*08596579* ��
PLEASE PRINT OR TY
Request Date Rough-In inspection required? ❑ Yes � No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
���� You must Call the inspector when ready! Date Ready:
I, �j licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Adtlress Street, Bax, or Route No. City Zip Code:
1�i STL7NY�RCyOK WAY ME FRtDtEY a5432
Section No. Township Name or No.__-�.-MM__ Range No. Fire No� County A�`
l�IOR�
Occupant MARTIN CHARLES W Phone No. __NY
Powe�$y�ier Address -y---'M--
n�;�r
Electrical Contractor / Company Name Contractor License No. Master Lic. No. (Plant Elect. Only)
HUNT EIEGTRIC GORP'QRATI4N GA 00883
Mailing2A��1Ua TERR��RORIAL ROAQP8SAi1�T PAUI� MN 56114
Authorized Signature (Contractor, Company or ��er�rmjng Ins 'on) Phone Number
�C 6 +U �j ' J�►� ( 6.57) 846-2591
EB-00001A-12 5/1999 STATE BOARD COPY � SEE INSTRUCTIONS ON BACK OF YELLOW COPY