Loading...
P - 81399I�li1IIIIIlIIIIIlIIIII IIII IIIIIIIIIIII II REQUEST FOR ELECTRICAL INSPECTION �� Minnesota State Board of Elechicity ���_. 1821 University Ave., Rm. 5-128, St. Paul, MN 55104 � � * 0 3 9 2 3 6 9 5* Pnone�sizJsaz-oeoo '��� ` Home Duplex Apt. Bldq. Other: New Addn abwe the wwk �.quip. Water Hh. -- Loatl Mgmt Other: Elec. Heat Temp. Service by this request Enter remarks in this space and on the back o1 the white copy SAVEk'S SWITCH INSTALLATION Calculafe In�ection Fee - This In;oectirn Reques[ wi!! not be accep[ed without the correct /ee: Olher 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 Tfansformer/Generator insrecroa'S use oN�v TOTALI�' J� Sign/Outline Ltg. Xfmr. j Alarm/Remot Swifllming PO I nerecy certity fiet � Inspec�etl �ne eiechioai Ins�al�ation aesoribetl �ereln on ihe datES statetl ,. IrrigationBoom . __ Rown-m oa�e Final Investigative Fee � THIS INSTALLATION MAY BE 392-36�5] DISCONNECTED IF NOT COMPLETED WI71iIN 18 MONTHS. OFFICE USE ONLY This reqi.est wid 18 moMhs irom valltlation tlate priMetl In ihis �ox. �/a6's,� JGB NUMBEk Ji9�0L,OJfd�i PLEASE PRINT OR TYPE Re4 RougMn Inspec�ion requiraf? �`/es ❑ Inspedlon OMer Than Rou9h-In_ Ready Now � Will Call IVOU mus� cell the lospeclor when reatly) �ato Reetly 11 �.j0 ��� I, licensed contractor ❑ owner hereby request lnspection oF Ihe a6ove electrical work at '°���$��fee1BOxor�'P�`e"P%2 WAY NE ��I?IDLEY ZP��43< Seotion No. Townshlp Name or No. Range Na Fre No_ Counry ANOK A oc�.VIN KOCINSKI Phone� 571-2994 Powar Supplior Address NSP MPLS OFFICE Eleclrical Conirsctor (Company Name) Con�rac�or Gcense No. MAbTER E.LECTRIC CO.,INL. CA01192 AAallirg Atltlress (ConVactor or Owncr Performing Inslallation) 12467 BOOHE AVE �.SAVAGE MN. 55378 Mast2r lia_ Np. AWhorrzaa SgnaNre �COntrdc[or or Owner Perbrming Inatalletlgp) Phone No. V " ` .,�i��.� � 941 4712/$90-3555 B-OOOOlA-11 8.�95 STATE BOARD COPV - SEE INSTqUCTIONS ON BACK OF YELLOW COPV