P - 81200� REQUEST FOR ELECTRICAL INSPECTION
' 0-854-613 0 Minnesota State Board of Electricity - _
1821 Universily Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us : `
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. X Load Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
X" above the work covered by this request. Enter remarks in this space and on tne back of the wn�te copy orny.
NSP SAVER'S SVIATGH INSTALLATION
Calculate Inspecti<
Jther Installations
Mobile Home Park Stall
Street Ltg./ Traffic Sig.
TransformedGenerator
Sign / Outline Ltg. Xfmr.
Alarm/Remote �optrpL
Irriaation Boom
Fee - This Inspection Request wi/l not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
�I herebvi certifv that I insDected the
without the correct fee.
Circuits / Feeders
0 to 100 Amps
Above 100 Amps
TOTAL ,
on the dates siated:
Investigative Fee �� ��� � U�—�Z^'�� �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
••-,_.... .....�..�,.�..,.....,..,.......W---- �- �--�- � W,..r .............
OFFiCE USE ONLY This request void 18 months from validatlon date printed in this box.
IIIIIIIIIIIIIIIIIIIIIIIIIIIIII� II�IIIII� ���/ �
� �
*08546137* �J��
PLE/6E�pNINu�ffR�A9OO000
Request Date Rough-In inspection required? ❑ Yes ❑ t�p Inspection Other Than Rough,k�: ❑ Ready Now ❑ Will Call
You must call the inspectar when readyf� Date Ready: � ��
I, [jQicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Ad�dress (Street, Bo��j R�WAY {.IV NE �� FRfDLEY �p �g54�
Section No. Township Name or No. Range No. Fire No. County �
•,.1,,
qiAVID P
(612j57�1423
Pqr'��yPPlier Addrg�,,,, � �Fl�
��a NR"L7
Electrical Contractor / Com an Name Contrador License No. Master Lic. No. (Plant Elect. Onty)
MAS"�ER E�EC�C CO.. {WC. CA0111i2
Mailing Address (Contractor, Company or Owner Performing Installation) B'Z 7—Q7�Z � ��2 J:.F�
��e7 Boa� avE s. sAV�. a�v. s��s t� t�-
Authorized Signature (Contractor, Co r Ow Performing Installation) Phone Number
_ f j+y ... �_ � �
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY