P - 81391.�II III I III II I III II II III I II II REaUEST FOR ELECTRICAL INSPECTION ���
Minnesota State Board of Electricity ^����a-_
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �� ��
* 0 3 9 2 0 9 0 7* Pnor,e�siz�saz-oaoo ��
;ommercial Industrial Farm F
\ir Cond. Htg. Equip. Water Htr. X Load Mgmt. Other:
>ryer Range Elec. Heat emp. Service
above rire work covered by fh�s request Enter remaJks in this s,oace and on the back o( the white copy
SAVcR'�� SWZTCH INSiALiATIC1N
Inspection Fee - This Inspection Request will not be accepted without the carec! �ee:
Olher Fee u Service Entrance Size Fee a Cirwits/Feeders Fee
le Home Park Stall 0 to 200 Amps 0 to 100 Amps
;t Ltg�./Traffic Sig. Above 200_Amps Above 100 Amps
;former/Genera}or INSPECTOR'S USE ONLY TOTAL
/Outlinz Ltg. Xfmr. . SP1
n/Remote Control
owninuu y rvni - t) � I hereby certiy ihat I Inspectetl ihe eleciricel lnsffiIlatlon describod herain on !he dates sfated
IrrigaYion Boo �" Rough-In Dale
„ Speciallnspection j , j�
Final Da�r> � ^ S �1
Investigative Fee �J l/
THIS INSTALLAiION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLV This reques[ mitl 18 monihs irwn valitlation tlate printetl In �his box.
392-09� , i5 �
/a6
JO8 NUM9G�i N5806u::��t
PLEASE PRINT OR TVPE
Requ�sf�a�4 ��� qough-in ins0eclion repuiretl? 0 Yes [k1JO Inspection 0[her Than Fough-Irt � Ready Now 0 Will Call
�YOU mus� call tlie inspecNr whm rsatly) Date Reatly
I, �] licensed contractor ❑ owner here6y request inspection of the above electrical work at:
Job Atltlress (9Veet, Box, or Foute NoJ Gty Zlp Gotle
td614Q1 E�F}i ST 11E FkIDLEY S'S43�
Sec�ion No. Townshlp Name or No. RanSe No. Fire No. Goun�y
ANCtKA
Occupan[ �none No.
�A2JL 3 i.OErf"LER 571-5879
Pow2r Supplier Atltlress
PLSP MPL:� OFFIG�
ElectrioffiConiractor(COmpanyName� ConttartorL�censeNo. Mastzrlk_NO_(PlenlElecLOny)
�RSTER ELECTHTC: CU. , I6ii. i;A�Di192
Mailiog Address (Con[ractor or Owner Psriwming InstallaHon)
� .� - c �-
Au[horized 51g re(CorRrnctor or Ownar Performing Inetalla9on) Phone No.
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n ,� -
EB-00001A-11 B/95 STATE 80ARD COPY - SEE INSTPUCTIONS ON BACK OF YELLOW COPY
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