P - 82252r
REQUEST FOR ELECTRICAL INSPECTION � °°
1�-Q 14-836 �9 Minnesota State Board of Electricity F-
1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us '.-'
Y Home Duplex Apt. Bldg. Other: New Addn
Commercial Intlustrial 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 antl on tne bacK ot tne wnire copy onry.
NSP SAVER'S SWITCH
Ca/cu/ate Insvection Fee - This Inspection Request will not be
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimmina Pool
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I hereby certity that I
Rough In
without the correct fee.
�ircuits / Feeders Fee
0 to 100 Amps
Above 100 Amps
�!�
described herein on the
Date
� � Irrvestigative Fee j" � �� 1 j// �/ I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
......••-• ....................... .........YU ., y.. .. .,. �..�, ,...,,-.Lc
>- I��p �I 4 LOFFICE USE ONLY This request void 18 months (rom validation dale printed in this box.
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PLEASE PRINT OR E
Request Date Rough-In inspection required? ❑ Yes ❑ No Inspec[ion Other Than Rough-In: ❑ Ready Now � Will Call
J� `,�, LyW 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 ZP ��e�
4802 WOt?DS�DE CT NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
• ANOKA
Occupant ROESKE SHARON L Phone No.
Power S���r nj ^� � Address
N r�i i� �
Electrical Contrector / Company Name Contractor License No. Master Lic. No. (Plant Elect. Onty)
HUNT ELECTRfC CORPORaT�ON CA Q0883
Mailing Address (Contractor, Company or Owner Performing Installation)
23�J0 TERRITORIAL ROAD , SAINT PAllL, IRAId 55114
Authorize/dj Signature /(C�/ontractor, Company or Owner Pertorming Installation) Phone Number
//L�IJI `f �M11iYY � QG� QA� �ii �
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EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY