P - 80801> REQUEST FOR ELECTRICAL INSPECTION �` E'
�V-V54-638 �4 Minnesota State Board of Electricity -
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 Intlustrial farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. X 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.
Calcu/ate
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote iii%Q
Boom
NSP SAVER'S S"1MTCH II�Si'Al.LATi+ON
Fee - This Inspection Request will not be accepted without the correct fee.
0 to 200 Amps 0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TOTAL ,
installation described herein on the dates stated:
Date
x Special Inspection 15,�
Investigative Fee F� oat�_22�d �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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_-- OFFICE USE ONLY This request void 18 montlis from validation date printed in this box.
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*08546384* �7�9
Request Date Rough-In inspection required? ❑ Yes ❑ f�p I Inspection Other Than RougF�yr ❑ Ready Now ❑ Will Call
� f,�,�� You must call the inspector when ready�� Date Ready: �� �� ���
I, [jQicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
�oJ�pSldfe,s� (Street, s�,�,� �,�te�i c"" FRlDLEY z'p c«'S5d32
Uaii:il
Section No. Tawnship Name or No. Range No. Fire No. County �
q�trC� � P Phone No. �612�J, 7R-B�0
Pq�rrpr�$ypplier Addr�s� � ���
tr�r• ��A••t-
Eledrical Contractor / Com an Name Conhactor License No. Master Lic. No. (Plant Elect. Only)
AAAS'iER ELEL"�C �0., iNC. CAi31iQZ
Mailing Address (Contractor, Company or Owner Performing Installabon)
12487 BO01� AVE S. SAVAOE. MN. �537 (812j841-47121 (612j8Q0-35li6
Authorized Signature (Cont om r Owner Perfortning Inst � Phone Number
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EB-00001A-72 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY