P - 80808REQUEST FOR ELECTRICAL INSPECTION �" °
�-854-631 � Minnes�ta State Board of Electricity
y 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.e/ectricity.state.mn.us :
Hame Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Contlitioner 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 tne bacK or tne wrnre copy onry.
IVSP SAUER'S SiMTGH I NSTALLATI �V
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Sign / Outline Ltg. Xfn
Alarm/Remote Control
Swimming Pool
Irriaation Boom
Fee - This Insvection Reauest will not be accepted without the correct fee.
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I hereb
Rough In
0 to 100 Amps
Above 100 E
TOT
installation described herein on t
Date
estigative Fee FN1e� � I oacu, �p•�dd I
/
THIS INSTALLATtON MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
_ .. . ., ._ ._. _ _ _._ .._ .. ..................._........».»,»,»...........,..,.r .
OFFICE USE ONLY This request void 18 manths from validation date printed in this box.
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*08546319* �7g�
Request Date I Rough-In inspection required? ❑ Yes ❑ I Inspection Other Than Roug - ❑ Ready Now ❑ Wi�l Ca�l
�,� �� You must call the inspector when ready� Date Ready: �.
�1�0A--
I, [�icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
�o��c�j�� (Street, a X � aoi4�%E�IVE �� FR(DLEY zp coae:
[1t��� 65432
Section No. Township Name or No. Range No. Fire No. County wtlrut a
/'YYV►v1
��� MARitYN KAY
($12)3a7-20T!
� _-i�LS OFFlCE
�al Contractor / Com an Name Contractor License No. Master Lic. No. (Plant Elect. Only)
�t Fc.ECi�c co.. rt+�c. cAO��a�
Addresa (Contractor, Company or Owner Pertorming Installation)
B7 �Qt� At/E S� 3JIVAGE. W1FV. 55378 (612j9d1-et7121 (012�90-35:i;
Authorized Signature (Contrector, Co r r Perfo��lyt�_Ttiq�) ^
� V � X
EB-00001A-12 5/1999 TATE BOARD COPY
I\ / I
SEE INSTRUCTIONS ON BACK OF YELLOW COPY