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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