P - 82574REQUEST FOR ELECTRICAL INSPECTION �,�,�'; ��� -`'E
'1-014-557 � Minrt,sota State Board of Electricity `F- 4��
. 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 �����.
(651) 642-0800 www.electricity.state.mn.us �
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Y. 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 only.
NSP �AVER'� SWITGH
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee.
Other Installations Fee # Service Entrance Size Fee # Circuits ! Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
TransformedGenerator INSPECTOR'S USE ONLY TOTAL
Sign / Outline Ltg. Xfmr. �•�
Alarm/Remote Control
Swimming Pool
I hereby certify that I inspected the electrical installation described herein on the dates stated:
Irrigation Boom Rough In Date
Special Inspection
Investigative Fee Pinal '' 2 3� Q
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE GNLY This request void 18 m hs trom validation date printed in this box.
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PLEASE PRI�FT 0F� �1lP� �`:�
Request Date Rough-In inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: LJ Ready Now ❑ Will Call
'�n� tiQ� �� 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.) Ciry Zip Code:
fi0z1 �JC7aDY LN NE FRiDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
------ --- ---------------------- • AN9KA
Occupant Phone No.
LINBLAD WAYNE H
Power s; �pl�r Address
Itl�7
Electrical Contractor / Company Name Contractor License No. Master Lic. No. (Plant Elect. Only)
HUNT ELECTRIC CORPORATION CA 00$83
Mailing Address (Contractor, Company or Owner Performing Installation)
2300 TERRITORIAL R(�AD , SAINT PAUL, MN 55114
Authorized Signature (Contractor, Company or Owner Pertorming Installation) Phone Number
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EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY