P - 81182REQUEST FOR ELECTRICAL INSPECTION �` E
V—U54-626 �9 Minnesota State Board of Electricity -
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993
{651) 642-0800 www.electricity.state.mn.us : "
Home Dupiex Apt. Bldg. Other: New Addn
Commercial Intlustrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
X" above the work covered by this request Enter remarks in fhis space and on the back of the white copy only.
NSP SAVER'S SWlTCH INSTAL.LATION
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransformedGenerator
Siqn / Outline Lta. Xfmr.
Fee - This Inspection Reauest will not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
without the correct fee.
Circuits / Feeders
0 to 100 Amps
Above 100 Amps
TOTAL ,
Date
Investigative Fee r�ne� / ',�„a� I"e� �� � I
�
THIS INSTALLATION MAY BE ORDERED DIS ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
....................Y...._.. �--- - W_.............................W.y...................�.W..._.�W.......,...,..,...._...,��..,..,.,......_...�._.,�__...
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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*08546269*
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Request Date Rough-In inspection required? � Yes ❑ Inspection Other Than Fiough�{n: O Ready Now � WNI Call
�,i7� You must call the inspector when ready� Date Ready: a M.���
I, [jQicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Jo�gcJp��s (Street, QQn, o'fjQutg (Vq� � City ��Y Zip Code:
7 �i4 7 l3 !"1 A1t �$�
Section No. Township Name or No. Range No. Fire No, County �A
°�4EC)ER DENNp S F
Pq�$�pplier
M�1.�
Electrical Contractor / Com � Name
MASTER ELEC�C CO.
Mailing Address (Contracta, Company a
�zas7 eoa� avE s, s
Phone No. �a�����
W
Addrgs�, � �F+�
Pfp"L
Contrecior License No. Master Lic. No, (Plant Elect. Onty)
INC. G1107 9�2
wner Performing Installation)
V�' . ►viN. S63�g f 012jQ41-0712 ! (692j89a-3556
lir Owner Pertorming Installatlon) Phone Number
EB-00001A-12 5/19�/ STATE BOAAU� � r'� � SEE INSTRUCTIONS ON BACK OF YELLOW CAPY