P - 815761°O � 9— ��i 7� REQUEST FOR ELECTRICAL INSPECTION �°E
`t Minnesota State Board of Electricity F:-
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 -- _
(651) 642-0800 www.electricity.stafe.mn.us ': '
'X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
1-019-147 6134-2000 � Inspected Locally
Robert Ciauson
{651) 777-7885
Ca/cu/ate Inspection Fee - This Inspection Request will not be accepted withoui the correct fee.
�ther Installations Fee # Service Entrance Size
Mobile Home Park Stali 0 to 200 Amps
Street Ltg. / Traffic Sig. Above 200 Amps
Transformer/Generator INSPECTOR'S USE ONLY
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
BOOfT1 Rough In
ispection
0 to 100 Amps
Above 100 Amps
TOTAL �
electrical installation described herein on
Date
Investigative Fee Finat � �-J—� �� :
THIS INSTALLATION MAY BE ORDERED ONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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�`—'—� � � J' ��ONLY This request v b 18 mon h fram valid� ation date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-In inspection required� Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ill Call
You must call the inspecto�en ready! Date Ready: �
I, �icensed contractor ❑ company ❑ owner hereby request inspection of the above electricai work at:
Job Address (Street, Box, orRoute NoJ Ciry Zip Code:
7411 Unive�si Ave Fridle
Section No. Township Name or No. Range No. Fire No. County
Anoka
kcupant J y1 � � �
Sunridge Homes ��� ��
(651)653-4032
Power Supplier Address
NSP 3115 Cent�e Po�ke Dme, Rosevdk, MtV 55113 -(859�28-2�0
Electrical Contractor / Company Name Contractor License No. Master Lic. No. (Plant Elect. C
Aircon Electric CorpoFation CAQ0141
Mailing Address (Contractor, Company or Owner Performing InstallaGOn)
2343135th Lane Nw -- Andover, MN 55304
Au1h 'zed Siflfihture (C . CDmp9nv or Owner Performinp Installation) Phone Number
EB-00001A-12 5/1999/ � STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW�COPY
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