P - 80993REQUEST FOR ELECTRICAL INSPECTION -
8 3�4 � 2 6 2 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
X Home Duplex Apt. Bldg. Other: New Addn
Commercial Industria) Farm Remod Re air
X Air X Htg. Equip. Water Htr. load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of fhe white copy only.
replacement furnace; replacement CAC
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Oudine Ltg. Xfmr. $20. 50
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins the electrical insmllation dexribed herein on Ihe dares stated
Irriaation Boom P,.....��., n..b
' Final ' �Q �� 7i -�iC� ^�
Imestigative Fee �/ � �__ �
THIS INSTALLATION MAY BE ORDERED DiSCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
, OFFICE USE ONLY This wquest void 18 monfhs from wlidafion dafe printed in this box.
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* 0 8 3 4 2 6 2 8* r7`7 7
PLEASE PRlNT OR TYPE
Request Date Rougf�in inspection required$ ❑ Yes � No Inspeclion O�er Than RougMn: � Ready Now � Will Call
10 / 21 / 9 9 (You must call the inspector when ready� Date Ready:
I, �licensed conhactor ❑ owner hereby request inspection of the above electrical work at:
Iob Address (Sheet, Box, or Route No.) Ciy Zip Code
1560 Trollha en Drive NE Fridley 55421
Section No. Township Name or No. Range No. Fire No. County
Occupanf Phone No.
Tom & Marv Arsenault 571-4705
lechical Conhacror (Compony Name) Conhactor License No. Master Lic, No. (Plant Elecf. Onl
Total Electric, Inc. CA02749
Aailing Address �Conhac�or w Owner PerForming InslallaTion)
10760 Mankato Street, NE suite 4�1 Blaine MN 55449
Wthoriz ignature �Conhactor or Ow Perfor ' sMllation �► J�� ;^�• _-i Phone No.
� J � (612) 786-8484
11 8/96 `
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY