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P - 80785� REQUEST FOR ELECTRICAL INSPECTION " E' Q—C�54-654 � Minnesota State Board of Electricity � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 -_ _ (651) 642-0800 www.e/ectricity.state.mn.us : ' 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. I�P SAVER'S SWITGH IIV5TALLAT►ON Calcu/ate lnspection Fee - This Inspection Request will not be accepted without Mobile Home Park Stall Street Ltg. / Traffic Sig. Transformer/Generator Sign / Outline Ltg. Xfmr. Alarm/Remote Control 0 to 200 Amps 0 to 100 Ai Above 200 Amps Above 100 INSPECTOR'S USE ONLY In TOTAL Date Investigative Fee FN'ei �— -" I oate,l/���� / THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS ���Y��v.� YwW�.Y���wY.4.� .�W���•�.OFFlCE USE ONLY�Triis request void 18 monihs from validation date printed in this box�„ IIIIIIIIIIIIIII�IIIIIII�I�I�IIII��I�� � � � � *Q8546541 * ���9 PLfi+�A�IN��O Request Date Rough-In inspection required? ❑ Yes � yp Inspection Other Than RoughrM: ❑ Ready Now ❑ Will Call Q����g You must call the inspector when readyl' Date Ready: �� �s�,�� I, []IGicensed contractor ❑ company ❑ owner hereby request inspection of the above e{ectrical work at: �oj���g (Street, B��rl�i�►� (� c�'� FRlC?LEY zip c��474 s»��� Section No. Township Name or No. Range No. Fire No. County ��b ROBERT K Addrgsy�„�� S ��+� NI��L MAa'TER ELEGG'TTRtC CO.. IfVC. I Mailing Address (Contractor, Company or Owner PeAortning Installatio 12A67 HOOWE AVE S. BAVAG�. AdM. 653,�� Authorized Signature (Contractor, Com�p�cc�wner Performing Installation) EB-00001A-12 5/7999�� STATE BOARD COPY Master Lic. (812j941-0712 ! (Q12�90-35�5 Phone Number \ � SEE INSTRUCTIONS ON BACK OF YELLOW COPY