P - 81070REQUEST FOR ELECTRICAL INSPECTION
0-858'348 � Minnesota State Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
` (651) 642-0800 www.electriciry.state.mn.us � : `�
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner 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.
N3P S/4VER'S 3W1TCH
Calculate Inspection Fee - This Inspection Reauest wil/ not be acceated without the correct fee.
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransformeNGenerator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
0 to 200 Amps 0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY T�
�b
I hereb ceRiy that I inspected the electrical installatio� described herein on the dates stated:
Irrigation Boop* y Rougn in Date
Speciallnsp �{
Finel Date � ,Z � � �.`
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
������M��f �~��vT��•��T� �T�� OFFlCE USE ONLY This request vob 18 months (rom validation date printed'm this box.
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*08583486* 6�7
PLEASE PRINT OR TY
Requgs�t�t�� Rough-In inspection required? ❑ Yes 0 No Inspection Other Than Rough-In: � Ready Now 0�II Call
�'����� You must call the inspector when ready! Date Ready:
I, ❑ licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Addr�et, �X, ��r,�. NE °ttj FRIDtfY �P �132
Sedion No. Township Name or No.._��_._�. Range No. Fire No.__.p� CounM��atlw
---• 711� IY1
Occupant NYGEN 1Ri VAN Phone No. _�
PowetiSllpNier Address ��,
ir���-
ElectriHU �NT ElE4�R�GamCURPt>RATtt?N COniractor Licens� � Master Lic. No. (Plant Elect. Onlyj
Mai�in�3W TE�KI I VFil�y ���PeiSR��►�, MN 55114
Authorized Signature (Contractor, Company or Owner Pertaming^Irt�% '� �� �ho�. � mv�7rr�� �
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E&00001A-72 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BAGK OF YEILOW COPY