P - 80759' REQUEST FOR ELECTRICAL INSPECTION `� E
.O_854'6�5 � Minnesota State Board of Electricity �N€- _
' 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 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 on/y.
NSP SRVER'S SVIATCH IIV�T'ALLATION
Calcu/ate Ins ecti�
Other Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Fee - This Inspection Request wil/ not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
" I hereb certi that 1 inspected the electrical install
Irrigation Boom - ^� Rough In
Speciallnspection 16.�
Investigative Fee ��
_. THIS INSTALLATION MAY BE ORDERED DiSCONNECTED IF NOT
• - •- - -- � -� -- - .. . -- - - - �--�--� -� - - --- - - --
without the correct fee.
Circuits / Feeders
0 to 100 Amps
Above 100 Amps
TOTAL ,
Date
18
OFFICE USE ONLY This requeffi vad 18 moMhs hom validation date printed in this box.
I IIIIII IIIII III�I �IIII IIIII II� IIIII IIII (II) I "W
* * �.i��%�
08546053
P�fi1�NW1d��189ti�000
Request Date Rough-In inspection required? ❑ Yes ❑ Inspection Other Than Rough3n: ❑ Ready Now ❑ Will Call
�1�� You must call the inspector when ready� Date Ready: . � �
na�i�inn
_... . � �
I, [aGicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Jo� (Street, Fli1KMVN (.7� � C�ry FRIDLEY zip �"35d32
Section No. Township Name or No. Range No. Fire No. Counry �
..e�AQ�Z "A�Y I Phone No. ♦Q������
RV'rR\7Y�f{ nV"Y� �U
„�.�.._. ��.�.s o�eE
Electrical Contractor / Com an Name Contractor License No. Master Lic. No. (Plent Elec[. Only)
hWSi�32 ELEC�'ii�G CO.. iNC. CAt31162
Mailing Address (Contractor, Company or Owner Performing Installation)
12467 BOONE AVE S. SAVAGE. MN, 5fi378 (�12jQ41-+3742 l(61Z�-355�'a
Authorized Signature (Contractor, Com an er Performin Iqs�t� n) Phone Number
'C � � ( )
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY