P - 82904REGIUEST FOR �LECTRICAL INSPECTION � �
6� ��� n� Minnesota State Board of Electricity
� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn ,
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. 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.
Calculate Inspection Fee - This Insp�
Other Fee
Mobile Home Park Stall
Street Ltg./TrafFic $ig.
Transformer/Generator
Sign/Outline Ltg. Xfmr.
Alarm/Remote Confrol
Swimminp Pool
�n Request will not be accepted withovt the correct fee:
# Service Entrance Size Fee # Circuits/Feeders Fee
0 to 200 Amps 0 to 100 Amps
Above 200 Am s Above 100 Amps
INSPECTOR'S USE ONLY TOTAL
15.50
thaf I inspected ihe eleclrical insmllation described herein on the da
I Dare
� Investigative Fee j` -_ � � �" %� ' ' -°`� � �'
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
�� I IIe� II III II III II �II OFRCE USE ONLY This request void 18 months from validation date printed in this box.
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* 0 6 4 1 2 2 6 6* ����
PLEASE PRINT OR TYPE
Request Dafe Rou h-in ins wn r uired?
9 P�� eq ❑ Yes [�NNo Inspecfion Olher Than RougMn: [$Ready Now � Will Call
6�3�9H (You musf call the inspecfor when ready) Date Reody:
I, [�licensed conhactor ❑ owner hereby request inspection of the above electrical work at:
lob Address �Sfrcef, Box, or Roufe No.) City Zip Code
1501 Windemere Dr Fridley 55432
Section No. Township Name or No. Range No. Fi2 No. Counfy
Occupanf
Bill Dietz
Power Supplier
Elechical Confmctor (Company Name)
Total Electric Inc.
Mailing Address �Conhactor or Owner PerFom
1537 92�fl Ln NE B
Authaized Si IConhactor or Owner Pe
MN 55449
Phone No.
571-4316
ior License No.
CA02749
1 8/96 �p� pRD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
u�. rb.
No.
786-8484