P - 80305REQUEST FOR ELECTRICAL INSPECTION �' F`'
�=852-998 �4 Minnesota State Board of Electricity -
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.elecfricity.state.mn.us : �
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Contlitioner Htg. Equip. Water Htr, x Load Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
'7C" above the work covered by this request Enter remarks in this space and on the back of the white copy only.
Calculate
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transtormer/Generator
Sign / Outline Ltg. Xfmr
Alarm/Remote Control
NSP SAVER'S SWtTCH lNSTAL.LATif�N
Fee - This lnspection Request will not be accepted without the correct fee.
;e # 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 hereby certity that I inspected the
Rough In
Investigative Fee F�� ��� _--___ I °a�� ��—O"t�
THIS INSTALLATION MAY BE ORDERED DIS NNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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OFFICE USE ONLY This request void 18 months hom validation date printed in this box.
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JUE3�NIBER �,i99DB000
*08529984* �7�
PLEASE PRINT OR TYPE
Request Date Rough-In inspection required?�7 Yes ❑ No Inspection Other Than Rough-In: Ready Now ❑ Will Call
'����f�� You must call the inspector when ready! Date Ready: '���f'��
I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) Ciry Zp Code:
QB17v HEATHER PL FRiC7LEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant Phone No.
ANDERSEN DALE C ($12)571-90$8
Power Supplier Address
NSP MPLS t?�FlCE
Eiec[rical Contractor / Company Name Contrector License No. Master Lic. No. (PIaM Elect: Onty)
MASiER ELEGTRI C GO. 1 MIG. CA01192
Mailing Address (Contractor, Company or Owner Perfortning Installation)
12Q@7 BOONE AVE S, SAVAGE, MN, 55378 (�'��)�1-4712 (892�9a-355
ed Sign ure (Contractor, Company or Owner Performing Installation) Phone Number
1 �
EB-00001A-12 5/199 BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY