P - 80765/
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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity H:�
1821 University Avenue Suite S-128, Saiot 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 ihis request. Enter remarks in this space and on the back of the white copy only.
NSP SAVERS SWITGH INSTALLATtON
Calculate lnspectic
�ther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransformedGenerator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
BOOfiI
Fee - This Inspection Request will not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I hereby
Rough In
without the correct fee.
Circuits / Feeders
0 to 100 Amps
Above 100 Amp.
TOTAL
insTallation described herein on
Investigative Fee F��� ����-S_�•--�_ I Date�`�/ �
>`°—
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN i MONT
.....,........,..�.....,.,.........._.........�.v�....................�............W�......W..........,W......... _. _._.....�....,..
OFFICE USE ONLY This request vdd 18 months from validatian date printed in this box.
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08545998
Request Date I Rough-In inspectio� required? O Yes �� I Inspection Other Than RougF�Jn: � Ready Now C] Will Call
� f�.��.y� You must call the inspector when rea Date Ready: « ����,�
I, [ jQicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Jo�s (Street, Qo�y�,Qp�q,�� �, � City ��� Z�P ���
iVa:�:�l a�i h'
Section No. Township Name or No. Range No. Fire No. County �
�� 1„EROY A REV Phone No. �612�7$-1i�26
PQ�PPIier AddrBS&�, S �Fl�
� an ���.
le trical ontractor / Com an Name Contrector License No. Master Lic. No. (Plant Elect. Only)
�!�as� a.�c�c co., �rvc. c,4a� �az
1�2$67 feSS� AVE S. o�ve� �i�nsta��7$ (g�2j841-47121 (�12�Dl3-3.��. 5
EB-OOOOtA-12 5/1999
._-- � �3 �i I c � I
BOARD COPY SEE INSTRUCTIONS ON BACK OF YELIOW COPY