P - 837904�:3-9�8 m
Home Duplex
Commercial Industri
Air Cond. Htg. Ec
Dryer Range
"X" above the work covered
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Other: New
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�I Farm Remod
uip. Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
by this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspecti
Other Fee
Mobile Home Park Stall
Street Ltg./Traffic Sig.
Transformer/Generator
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
i
Irrigafion Boom
Special Irespecti , /� .-:
on Reques► will not be accepted wiihout the correct fee:
# Service Entrance Size Fee # Circuits/Feed�
0 to 200 Amps ,'�Si� ( 0 to 100 Amps
Above 200 Am s Above 100
INSPECTOR'S USE ONLY TC
Fee
I 3�,ov
.f -�9'iZ � .�`�
c30..$�
that I inspected the electrical installation described herein on the dates stated
Investigative Fee v v r 7 ����� � uare�// q
C
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFflCE USE ONIY This requesf void 18 monfhs from validafion date printed in this box.
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I II III II i II III II III I IIII z
* � 4 7 3 9 4 8 8�c PLEASE PRINT OR TYP�� ���� ✓v �
Request Date Rough-in inspection required? ❑ Yes
�No Inspecfion Other Than Rough-In: ❑ Ready Now �Will Call
9/ 10 / 9 7 �You musf call fhe inspecfor when ready) Date Ready:
I, �icensed contractor ❑ owner hereby request inspection of the above electrical work at:
lob Address (Street, Box, or Route No.) �'y F r i d 1 e y Z'P ��4 3 2
323 Logan Parkway
Section No. Township Name or No. Ronqe No. Fire No. CounN
Occupant
BillNelson
� Ramsey
Phone No.
Power Supplier Address
NSP
Electrical Confractor (Company Name� Conhacfor License No.
Bassing Electric, Inc. CA00237
Mailin Ad r ss (Conhacror or Owner PerfqrLniTng InsfaJ�gtion)
1a3��+ McKay Dr 1�1L Ham Lake
Authorized Siqnature IConhactor or Owner Performina Installafionl ._ i i -.
COPY - SEE INSTRUCTIONS
Lic. No. �Plant Elect. Only)
�=3298