P - 81389i� rppI�� REQUEST FOR ELECTRICAL INSPECTION ��ff�4 I
I ,., IIIIIII II I�I I�II I I I I I IIII I II Minnesota State Board of Elechicity �,
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1821 University Ave.. Rm. 5-128, SL Paul, MN 55104 ��; �,
* 0 3 9 2 3 4 7 1 * Phone (612) 642-0800 '�•���
above the wak covered by
Other:
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SAVEk'S SWITCH INSTALLATION
ulate In`pection Fee - This lnspectiwr Fequest will nof be acceptetl withouf [he correct /ee:
O[her Fee ++ Service Entrance Siu Fee � Circuils/Feedere
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Am
TransformeNGenerator INSPECTOR'S USE ONLV TOTAI
Sign/Outline Ltg. Xfmr. �
Alarm/Remote Conhol
S P I r
wimming oo I hereby oar6ry �nat i mspectetl the electrical lrstella�ion descnbetl I»reln on �he tlatss s�atetl
Iff193t100 BOOfII � "� Rough-In Da�e
Fee
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Flnal I Da s� �� 7 J�
Investigative Fee _�i- — J � �
THIS INSTALLATION MAV BE ORDERED DISCONNECTED IF NOT COMPLETE� W�TNiN iR MONTHS.
� � OFFICE llrbNLV This reques� �roitl 18 mon�hs irom validation tlate prin[etl la ihls box.
392-347�]1 • /�� s- 5a
SOB NUMBER #e980E�0@
Reque � e Rough-in �inspecimn requirea? p ves p�ho I Inspection O�ner man Aougn-im p` Ready Now p wm c
1Yw mus� ca�� me inspectw wnen ready) oate Reetlg 11 / 3Q / i�+
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
�o�ergs�(�veeteo..o�iN°�T NE �}?IDLEY zip��432
se��ro� No. T��sn��a name o� r�o. aa�ee r�o. Fo-e No. co��cy ANOK A
PATRIGIA
Power Supplier
N5P
Phone No.
DUFRESNE 571-6392
MPLS t]FFICE
Eleclrical Gon�mcror (Comparry Name) ConVac�w Gcense No-
MASTER ELECTRIC CO.,INC. l'.A01192 I
MeiGng Atltlress �COnKactor or Owner Psriorming Instal�ation)
12467 BOONE AVE S. SAVAGE MN. 55378
AulMdzed SgnaNre �COn[ractor or Owner PeAOrming InsYallafion) ���
" 541
EB-00001A-11 8/95 STATE BOAFO COPY - SEE tNSTNULTIONS ON BAGK OF YELLOW COPV
Lio- No. IPlant Elect
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