P - 82251�
����R REQUEST FOR ELECTRICAL INSPECTION � °E
—"�� � Minnesota State Board of Electricity Fi-
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 =
(651) 642-0800 www.electricity.state.mn.us
v Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Contlitioner 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 on/y.
NSP SAYER'S SWITCN
Calcu/ate Inspection Fee - This Inspection Repuest wil/ not be accevted without the crorrect fee.
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransformedGenerator
SignJ Outline Ltg. Xfmr.
Alarm/Remote Controi
Swimming Pool
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
0 to 100 Amps
Above 100 Amps
TOTAL
�.�
I hereby certi that I ins ected the electrical installation described herefn on the dates stated:
If�198t1Of1 B00 � Rough In � Date
Special Insp
Investigative Fee Final o G �� �^ C
THIS INSTALLATION MAY BE ORDERED DiSCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
..................................................................................... ........... ....... .........................��•�._•_ _•.�-.-._ -.�...,....,........,.,..:,....,.....,...._..._......_.
I II`III IIIII IIIII IIIII IIIII II� ��II I�I OFFICE USE ONLY This request void 18 rrwnths from validation da� r�ed in� ox.
I
*101 48 6* • 'j�`YO�
' PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes ❑ N� Inspection Other Than Rough-In: Ready Now ❑ Will Call
Su� �� � You must call the inspector when ready! Date Ready:
I, [�4icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route Na.) Ciry Zip Code:
5514 Vtt BP1V�tRtAM �A� FRIQ�EY 55432
Section No. Township Name or No. Range No. Fire No. County
• ANQltA
Occupant Phone No.
ANDERSON PATRtC1A LENORE
Power"�pl�r �� � Address
tV�7 �
Electrical Contractor / Company Name Contractor License No. Master Lic. No. (Plant Elect. Only)
HUNT ELECTRtC CORPORATION CA 00883
Mailing Address (Contractor, Company or Owner Performing Installation)
23�D TERRITQRIAL ROP.D , SAINT PAUL, MN 55114
Authorized Signature (Contractor, Company or Owner Performing Installation) Phone Number
� � Q5� 84�-2911
EB-OOOOtA-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY