P - 80803' REQUEST FOR ELECTRICAL INSPECTION
Q—Ca54-636 � Minnesota State Board of Electricity
f� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 551044993 -
(651) 642-0800 www.e/ectricity.state.mn.us
Home Duplex Apt. Bldg. Other: New Atldn
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'�"a SWITGH INSTALLATION
Fee - This Inspection Request will not be accepted without the correct fee.
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. /'Traffic Sig. Above 200 Amps Above 100 Amps
TransformedGenerator INSPECTOR'S USE ONLY TOTAL
Sign ! Outfine ttg. Xfmr. a� �
Alarm/Remote I
Swimming P
Irrigation Boom i nereb certi(y that I inspected the electrical installatlon described herein on the dates stated:
Rough In Date
Investigative Fee Ff�� �� I�� 2zda � I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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OFFlCE USE ONLY•This requeat void 18 months from validation date priMed in this box.
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Request Date Rough-In inspection required? ❑ Yes ❑ I� Inspection Other Than RougFdn: 0 Ready Now ❑ Will Call
�� �� You must call the inspector when ready!' Date Ready: �Z __ __ _�_
I, [a4icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
�o� (Street, BJ��°�v�VE i� c;Ty FRIDL.EY z�P cwe:
55432
Section No. Township Name or No. Range Na. Fire No. County �A
� MAVI S J
Phone No. ���Z�,���
puer Add
r�S �iCE
ontractor / Com n Name Contractor License No. Master Lic. No. (Plant Elect. Only)
�2 ELEG"�C CCl., tNC. CA011GZ
Iress (Contractor, Company or Owner Performing Installation)
800NE AVE S. �►VAGE. h�V. $537$ (B12j�41-0712 ! (012�-35�
Signature (Contrector, C pen er Performing Install Phone Number
_ _ �`�32.� c �
EB-00001A-12 5/1� STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY