P - 82246�
.1 -� 1 �1 _83� � REQUEST FOR ELECTRICAL INSPECTION , ' ° �
`f Minnesota State Board of Electricity F:- °�
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 � _
(651) 642-0800 www.electricity.state.mn.us
:: Home Duplex 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 by this request. Enter remarks in this space and on the back of the white copy on/y.
N�P SAVER'S SWITGti
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee.
Installations Fee # Service Entrance Size Fee # Circuits / Feeders
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransformedGenerator
Sign / Outline Ltg. Xfmr.
Alarrn/Remote Control
Swimming Pool
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
0 to 100 Amps
Above 100 Amps
TOJ�.4l.._
2Q 5O
I hereb certity that I inspected the electrical installation described herein on the dates stated:
Ifflg8tl0� BOO Rough In Date
Special Inspe
Final Date
Investigative Fee - � � "�
THIS INSTALLATION MAY BE ORDERED DIS NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
•_.-.1,,,�.s._.,.y.�,s.,..u,..��-.s:1_-'_ __ti._-._._._�..� _: _._ _.._. _..._._. _._._._.,_...�.:,._'-._ :,_,�u ...................�. ...................................
I IIIII) IIIII IIIII III�I IIII) III I`II� IIII IIII OFFICE USE ONLY This request vad 18 months from validation date printed in this box.
� a� -�
*10�48 1 * � L�/���
PLEASE PRINT OR E
Request Date Rough-In inspection required? � Yes � No Inspection Other Than Rough-In: ❑ Ready Now O Will Call
'uf� �� �,f�Q You must call the inspector when ready! Date Ready:
I, [jiicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Route No.) Ciry Z�P �8�
6t70 TRtIV�TY DR NE FR�D�EY 55432
Section No. Township Name or No. Range No. Fire No. Coun/�ty y�
� ' ' /'ti�QRI'l
�cu`��� JOHNSQN LYLE J Pho�e No.
Power iSN��� 2 $2 � Address
N
Electrical Contractor / Company Name Contraclor License No. Master Lic. No. (Plant Elect. Only)
HUNT ELECTRtC CORPORATION CA 00883
Mailing Address (Contractor, Company or Owner Perfortning Installation)
2� TERRITflRIP.L ROAD , SAIIdT PAUL, MN 55114
Authorized Signature (Contractor, Company or Owner Perfortning Installation) Phone Number
i�'�oet�awc ( 6S� �2911
EB•00001A-12 S/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPV