P - 81065REQUEST FOR ELECTRICAL INSPECTION
O`8%9'6'� 1 � Minnesota State Board of Electriciry _
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.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 white copy on/y.
NSP �AVER'S 3WITCH
Calculate Inspecii�
Other Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Contro!
Swimmina Pool
Fee - This Inspection Repuest will not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
Rough In
that I
without the correci fee.
Circuits / Feeders
0 to 100 Amps
Above 100 Amps
Date
Investigative Fee rma� � ���` I ucya��'�3_ ��I
C
THIS INSTALLATION MAY BE ORDERED DISC CTED IF NOT COMPLETED WITHIN 18 MONTHS.
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--' OfFICE USE ONLY This request void 18 months from validation date printed in this box.
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PLEASE PRINT OR TY
Request Date Rough-In inspection required? O Yes ❑ No Inspection Other Than Rough-In: Ready Now ��II 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 Rouce No. City Z�P �e�
66St3 W BAV�►RIAN PAS FRIDLEY 55431
Section No. Township Name or No._M Range No. Fire No. County�
Occupant REItAND 8AR8ARA ANN Phone No. �N
Powe��Sypp�ier Address _�.s.
N�(�
Electrical Contractor / Company Name Contractor License No. Master Lic. No. (PIaM Elect. Onry)
HUNT ELEGTRtC CQRPGRATIiDN �A 00863
Mailing Address (Contractor, Company or Owner Performing Installation)
23Q0 TERRRi)RlAL ROAD , SAINT PAUL, MN 65114
Authorized Signature (Contractor, C or Owner Performing In I'on) .y Phone Number
� � j `, , ltld�d!M+K ( �1) 646-2911
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY