P - 81155E
REQUEST FOR ELECTRICAL INSPECTION
lJ_$58�2�7 � Minnesota State Board of Electricity _
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electriciry.state.mn.us
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Contlitioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
X" above the work covered by this request. Enter remarks in this space and on the back of the whrte copy only.
N3P SAVER'3 3WITCH
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimminq Pool
Fee - This Inspection Request will not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I herebvi certiN that I
without the correct fee.
Circuits / Feeders
0 to 100 Amps
Above 100 Amns
• l.�. �
n on the
Date
Special Inspecfixln � J i,J E i
Investigative Fee �� �' �a� —2 —�
THIS INSTALLATION MAY BE ORDERED CTED IF NOT COMPLETED WITHIN 18 MONTHS.
-�.~.`_.M��M^.~,,,.R��»......�x�M�..H ��� OFFICE USE ONLY This request void 18 months from validation date printed in this box.
IIIIIIIINIIIIIIIIINIIIIIIIIII�I���I • � -�
*os582s�s* �6�
Request Date I Rough-In inspectian required? � Yes � No I Inspection Other Than Rough-In: Ready Now � Wfll Call
� ���� I You must call the inspector when ready! Date Ready:
I, �j licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Adtlress (Street, Box, or Rou[e No.) Cily Zip Code:
t591 TRt7l,LHAGEIV DR FRfD�EY 564Z1
Section No. Township Name or No. � Range No. Fire No. Counly���A
17yM
Occupant F,�pEW wM w Phone No. .M__'
Powe4$ypy�ier Address
N�t�
Electrical ConVactor / Company Name Contractor License No. Master Lic. No. (PIaM Elect. Only)
HUNT EtEGTRiC CORPGFRATtQN CA 0088;i
Mailing Address (Contractor, Company w Owner Pertorming Installallon)
2300 TERRIIURW. RC?AD , SAiNT PAUL, MN �5114
Authorized Signature (Contracgn �npany or Owner PeHortning Ins I'on) Phone Number
'`' � c� � `� J�i� ( �7) 646-281 ?
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY