P - 81144/
�-858-300 []7
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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Avenue Suite S-728, Saint Paul, Minnesota 55704-2993 =_ _
(651) 642-0800 www.electricity.state.mn.us
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Loatl 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 only.
N3P 3AVfR'S 3WtTCH
Calcu/ate Insnecfion Fee - This Insoection Reauest will not be accepted without the correct fee.
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TO�
Sign / Outline Ltg. Xfmr. �Q;,Sd
Alarm/Remote Control
Swimming Pool
I hereb certi(y that I inspected the electrical installation described herein on the dates stated:
Irrigation Boom Rough In Date
Special Insp ' �" "�
Investigative Fee �� t -- 1- —O
THIS INSTALLATION MAY BE ORDERED DIS NECTED IF NOT COMPLETED WI HIN 18 MONTHS.
- .............._...... �.� __.�,�...m..:.....�,.._.......�......,.�.........�.....�.�.......�....��...._� . .
OPFICE USE ONLY This requesl vad 18 months from validation date printed in this box.
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PLEASE PRINT OR TY
Request Date Rou h-In ins ection
g p required? O Yes ❑ No Inspection Other Than Rough-In: Ready Now ❑ Will Call
� ���� You must call the inspector when ready! Date Ready:
I, �] licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address Street, Box, or Route No. City Zip Code:
73�0 VAM 8l�REIV 3T NE FRIDLEY 56432
Sectlon No. Township Name or No.�� Range No. Fire No�� County���w
n17V1V1
�cU��t !EE YI—YING Phone No. .__-M
Power� y�er Address �.�w
s
Electrical Contractor / Comparyr Name Contractor License No. Master Lic. No: (PIaM Elec[. Onty)
HUNT ELECTRIG CORPQRATI4N GA 0�83
Mailing Address (Contractor, Company or Owner Performing Installatio�)
2300 TERR(nDR1AL RC)AD , SAIINT PAUL, MN 66114
Authorized Signature (Co�by C�o�n ny or Owner Performing'In I'on) Phone Number
� t� �� J�� ( B.51) 646-28Y t
EB-OOOOtA-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY