P - 82107�
�j REQUEST FOR ELECTRICAL INSPECTION �'HE.
1'-0 ��'" �� � Minnesota State Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 -_ _
(651) 642-0800 www.electricity.state.mn.us . '
X Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial 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 this space and on the back of the white copy on/y.
NSP SAVER'S SWITCH
Ca/culate Inspection Fee - This lnspection Reauest wil/ not be accepted without the correct fee.
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outiine Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
0 to 100 Amps
Above 100
TOTAL
20.6a
I herebv certiiv that f inscected the eledrical installation described herein on the dates stated:
"y"""" " " �'�f � Rough In � Date
Speciallnspec n �
Investigative Fee FApd Dat� s^ G/
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
—_s,,L_ ___—__�'_-------------
_^r ... ... .............................................OFFICE USE ONLY This�request vdd 18 months from validation date printed in this box.............
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�* 1 0 1 1 6 s* � a��7
PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes ❑ N� Inspectlon Other Than Rough-In: LJmeady Now � Will Call
��Z�� You must call the inspector when ready! Date Ready:
I, Qg licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Route No.) City Z�P �e�
� 75rH WAY NE FR�DLEY MN 55d32300 56433
Section No. Township Name or No. Range No. Fire No. County
---------- ------ --------------- ------------ ANGKA
Occupant Phone No.
LADE SU3AN L ------
Power Supplier Address
N3P ' •� - -----------
Electrical Contractor / Company Name Contractor License No. Master Lic. No. (Plant Elect. Onty)
Mailing Address (Contractor, Company or Owner Performing Installation)
2300 TERRITORIAL ROAD SAINT PP►UI., MN 5�5114
Authorized Signature (Contrac[or, Company or Owner Performing Installation) Phone Number
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EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY