P - 83058lilllll �IIII IIIII I�I�I IIIII IIIII I�I�I �IIII III� IIII
�03808714*
REQUEST FOR ELECTRICAL INSPECTfON ��
Minnesota State Board of Electricity � °i
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 ��'�'=�
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. L d Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by this request Enter remarks in this space and on the back of the white cqoy only.
SAVER'S SWITCH ITISTALLATION
Calculate Inspection Fee - This �nspection Request wi�l not be accepted without the correct tee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr.
AlarmlRemote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom J Rough-In Date
Special Inspection oa
In tigative Fee ' � cs-�_ --'�"
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request vad 18 from validation date printed in this box.
380-871� �� �
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PLEASE PRINT OR TYPE JOB NUMHER #9706 �
Request Date Rough-in inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
8/ 14 / 98 (You must call the inspector when ready) �te Ready: x
I, ❑ licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Addre (Street, Box, or Raute No.) City Zip Code
Section No. ame or No. o. o. nty
Occupant PFwne No.
Power Sup�lie� VQ��E Addr�
Electrical C���pr (Company Name) r r l�i�.(;E Master Lic. No. (Plant Elect. Only)
MailingAda����o,�����st�> � INC. CA01192
Authorized;ic�nat4ur&(�ntr�tptp� Q�er P�rJpr�ing�qs;al�icyil�A� Y �5.3.78 Phone No.
G t�-/ UlJ[�t !� V C. b A V �S� .
V
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COP1FjQ 1—�% 1� I8g0— 3ScJ