P - 82205REQUEST FOR ELECTRICAL INSPECTION �" E`
.1 L011-459 []3 Minnesota State Board of Electricity F+-
�� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.elecfricity.state.mn.us : `
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Loatl 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 o► tne wnite copy onry.
MSP SAVER'S SWITCH
Calculate Inspectii
Dther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimmina Pool
Fee - This Inspection Request will not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I herebvi certifv that I insoected the electrical
�ted without the correct fee.
# Circuits / Feeders
0 to 100 Amps
Above 100 Amas
0
on tl�e dates stated:
Investigative Fee � �� ll �� �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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I IIIII� IIIII IIIII IIIII IIIII III 1.'II II�I (III OFFICE USE ONLY This request void 18 moMhs from validation date printed in ihis box.
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* 1 0 1 1 4 3* � �,��
PLEASE PRINT OR TY
Request Date Rough-In inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
�27�� You must call the inspector when ready! Date Ready:
I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Add eet, Box, or R t City Zp Code:
�� Sl���l'ONY ST NE FRID�.EY 5543Z
Sec4ion No. Township Name or No. -__�_�N_N Range No. Fire No. __�Y CountyA "�
'--------- ------ ---- lU'1
Occupant OKSNEVAD HAAIG�N B Phone No. ______
Power $ypp�er O � Address
Nsr � w -----------
Electrical Contractor / Company Name Contractor License No. Master Lic. No. (Plant Elect. Only)
HUNT ELECTRiG CORPGRATtON CA 00883
Mailing Address (Contractor, Company or Owner Performing Installation)
2300 TERRITQRIAI ROAD , SAINT PAUI, MN 5,5114
Authorized Signature (Contractor, Company or Owner Performing Ins Ilation) Phone Number
��� ( &5'� 646-2911
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY