P - 80760r
E
REQUEST FOR ELECTRICAL INSPECTION
O_854_6�4 � Minnesota State Board of Electricity __
1821 University Avenue Suite 5-128, 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 Loatl Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
X" above the work covered by this request. Enter remarks in this space and on fhe back of the white copy on/y.
NSP SAVER'S aV1ATCH INSTALLACTION
Calcu/ate Inspection Fee - This Insvection Reauest will not be accepted without the correct fee.
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I hereby certity that I
Rough In
0 to 100 Amps
Above 100 Amp;
TOTAL
.
n described herein on the da
Date
�� Investigative Fee � � � ` �/�L..c�-o^�^�— �� Y�'��! �
THIS iNSTALLATION MAY BE ORDERED_DI ��ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
...��,,..3,..._,�.� ...,._.�..,,.. . .
OFFlCE USE ONLY This request void 18 montlre from validation date printed in this box.
' I IIIIII IIIII III'I'IIII IIIII IIIII � I� III) �
, *08546046* °�`3
Request Date Rou h-In ins ection re uired? ❑ Yes ❑� Ins ection Other Than Rou F�}
g p q p gAn: ❑ Ready Now ❑ Will Call
_�,���g You must call the inspector when rea bate Ready: � jA'�
I, [jQicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
�a� n�da�� cs«��, �. X�1�WESilIL�.E ST (� ��`� FRlDLEY Z�P �5643�
Section No. Township Name or No. Range No. Fire No. County �
�-,�
Pryn�,$,�pplier
IV7�'
lectri I Contractor / Com an Name
iEK ELE�C CO., iNC.
Mailin Address (Contractor, Company or Owner Pe
12�87 800AIE AVE S. SAVAC�+
Authorized Signature (Contractor, Company ,
EB-00001A-12 5/1999 �TATE BOARD COPY
I��ri�ll_l�
(612j7�-�[16Z
(012�Q1-Q7121 (012�-3555
PFwne Number
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SEE INSTRUCTIONS ON BACK OF YELIOW COPY