P - 80789-� REQUEST FOR ELECTRICAL WSPECTION �E
Q�54-650 []9 Minnesota State Board of Electricity
� 1821 Universiiy Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electriciry.state.mn.us � r -''
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industria{ Farm Remod Repair
Air Contlitioner 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 only.
NSP �AVER'� SWITGH INSTRLLATION
Ca/cu/ate Inspection Fee - This Inspection Request will not be accepted without the correct fee.
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Boom
� Service Entrance Size Fee # Circuits / Feeders
0 to 200 Amps 0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TOTAL .
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I herebv certifv that I insoected the electrical installation described herein on ttie dat
In
Date
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Investigative Fee �� � �.�_ , � ' ;
THIS INSTALLATION MAY BE ORDERED NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
�y�. �� .^����.T��������„,w��mw�� OFFlCE USE ONLY This request void 18 mwNhs from validation date printed in this box.
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* * '��99
08546509
PL��I�.
Request Date Rough-In inspection required? ❑ Yes ❑ 1� Inspection Other Than RougMn: � Ready Now ❑ wll Call
�1�� You must call the inspector when readyl Date Ready: �
I, 00icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
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Section No. Township Name or No. Range No. Fire No. County �
Jt�W E
Pq��pplier
iV�l..`
Addrg� ,5,� ��
P/R"L.
Electrical Contractor / Com n Name Contractor License No. Master Lic. No. (PIaM E{ect. On{y)
aws�R �c�c co.. rrvec. eno� ��
Mailing Address (Contractor, Company or Owner Performing Installation)
12887 8001� AVE S. SAVAGE. MN. 66378 (812�41-d7121 (612�35�5
Autharized Signature (C er Performing InstZltyti� ��� �hone Number
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EB-OOOOtA-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY
Phone No.