P - 82584REQUEST FOR ELECTRICAL INSPECTION `� E
1--014-559 07 ���� �
Minnesota State Board of Electricity ,���!�'.
. 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 r�..�1.�.
� (651) 642-0800 www.e/ectricify.state.mn.us '��:��
Home Duplex Apt. Bldg. Other: New Atldn
Commercial Industrial Farm Remotl Repair
Air Conditioner Htg. Equip. Water Htr. Loatl 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.
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NSP SAVER'� �WITCH '� � � � �
Calculate lnspection Fee - This Inspeciion Request will not be accepted without the correct fee.
Other Instal�ations 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. � �
Alarm/Remote Control
Swimming Pool
I hereby certiTy that I inspected the electrical installation described herein on the dates stated:
Irrigation Boom Rough In Date
Special Inspection
g Final � � � ^ O �
Investi ative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� OFFICE USE ONLY This request void 18�months from validation date printed in this box. -
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PLEASE PRINT �Ft �YP�
Request Date Rough-In inspection required? 0 Yes ❑ Nd• Ins ection Other Than Rou h-In:
P g C�Ready Now � Will Call
p You must call the inspector when ready! Date Ready:
I, [�icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) �ity Zip Code:
Section No. Township Name or No. Range No. Fire No. County
------ --- -------------------- AN9KA
Occupant . Phone No.
LASSI JOYCE K
Power Supplier Address
NSP
Electrical Contractor / Company Name Contractor License No. Master Lic. No. (Plant Elect.
Mailing Address (Contractor, Company or Owner PeAorming
av � e�rn 1 VKfP.L K(JAD �P.IIdT PA�!L Mld 55114
Signature (Contractor, Company or Owner Performing Installation) Phone Number
EB-OOOOtA-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY