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� REQUEST FOR ELECTRICAL INSPECTION �` °"
Minnesota State Board of Electricity 3
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 -_ _
(651) 642-0800 www.electricity.state.mn.us . `"
x Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner 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.
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Calcu/ate Inspection Fee - This Inspection Request will not be accepted without the correct fee.
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
0 to 200 Amps 0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TO AL
.�l50
I herebvi certiN that I insoected the electrical installation described herefn on the dat
""�_""' _-"". x ,.. Rough in Date
Speciallnspe �
Investigative Fee �"�� � � (r G � ^
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
.� ..^•�^'•-•^.^.-(r �.:;^ •-•� �•-•-•^�^�..-..s .....................................•..,,.••.•..,.,..This reQuest void 18 monMs from validation date printed in this box.'....
I IIIIII IIIII IIIII II�II IIIII IIIII IIII �l I�I OFFICE USE ONLY
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PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes ❑ No Inspec[ion Other Than Rough-In: ❑ Ready Now ❑�II Call
V41., 27� �� You must call the inspector when ready! Date Ready:
I, [7�4icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) Ciry Zip Code:
7408 WEST CIR NE FRIDLEY 7418
Section No. Township Name or No. Range No. Fire No. Cou�tllnO�a
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Occupant Phone No.
SCHULTZ DENNIS A
Power Supplier �. .. . Address
NSP `-� � e�1
EiearyHUN��EI.�����?I�'.eCORPORATION co�t c�r �q�p�o. Master Lic. No. (Plant Elect. Only)
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Mailing$dp�s�r�y� y�r pr 6w�er�fixfo'rt�rqilactuYet�11 t1 , MN 56114
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Authoriz ignatu ractor, Company or Owner Performing InstallaGon) �h�yumhes� � 1
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EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW CAPY