P - 80761REQUEST FOR ELECTRICAL INSPECTION �'� '
-Q-854-603 8[� 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 Contlitioner Htg. Equip. Water Htr. X Loatl Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
X" above the work covered by this request. Enter remarks in this space arrd on the back of the white copy only.
NSP SAVER'S SWlTCH INStAUAZ10N
Calcu/ate Inspection Fee - This Inspection Request will not be accepted without the correct fee.
�ther 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
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Po
I hereby certify that I inspected the electrical installation described herein on the dates stated:
Iff198t10t1 BOO t � R� Rough In Date
Speciallnspection jl�jp
rma� uat „0�
Investigative Fee --�,%
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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OPFICE USE ONLY This request void 18 months from validation date printed in this box,
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08546038
Request Date Rough-In inspection required? ❑ Yes ❑ Inspection Other Than Rough1n: ❑ Ready Now � Will Call
,�,,,.�,,,,�,,, You must call the inspector when ready� Date Ready: 1�
I, [jQicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box or Route No.) Ciry Zip Code:
0011D 6�RD WAY NE FRIa-EY 56432
Sectian No. Township Name or No. Range No. Fire No. County �
���� SYLVESTER L Phone No. �@�Z,C��r���
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P�pplier Addrg�„„ ,y,� �Fl�
IY�L
Electrical Contractor / Com an Name Contractor License No. Master Lic. No. (Plant Elect. Only)
aAASTER QEC'�R�C CO.. INC. CA01ia;t
Mailing Address (Contractor, Company or Owner Pertorming Installation) �'� �-07i� I V�i� �
42467 �E AVE S, SAVAGE. MN. 55378 I � i i�-
Authorized Signature (Contrector, Gom r ner Perfortnin�s�t�)� Phone Number
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EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY