P - 81168. REQUEST FOR ELECTRICAL INSPECTION
(�_8iJ8_3'� 7 � Minnesota State Board of Electricity
�f 1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.e/ectricity.state.mn.us ':-- '
'X" above the work covered by this request Enter remarks in this space and on the back of the white copy only.
asP sAVER�s swrrcH
Calculate lnspection Fee - This lnspection Request will not be accepted without the correct tee.
Mobile Home Park Stall
Street Ltg. ! Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irriaation Boom
0 to 200 Amps 0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TO� I�
I hereb certify that I inspected the electrical instellation described herein on the dates stated:
Rough In Date
Special Insp
Investigative e �� oate Z�� 2— �/
THIS INSTALLATION MAY BE ORDERED DI NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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. ................. ...................... . ... �........,...--�-------°--------._..
OFFICE USE OIIIY This requod vdd 18 months from validation date priMetl in this box.
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PLEASE PRINT OR
Requ���t�� Rough-In inspection required? � Yes ❑ No Inspectlon Other Than Rough-In: � Ready Now 0 Will Call
.' �r��� You must cafl the inspector when ready! pate Ready:
I, ❑ licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Addrp�J�eet� Box, NIVNICVC ��E °i�' Ff?IDLEY Z�P �V9+�
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Section No. Townsh'ry Name or No._�. Range No. Fre No.W� Count�wuetiVw
� _ �. i�urvrv�
Occupant REIZER JON N Phone No. �.
Powe►S�elier Address ___�._w
19�r
ElectriHl �o'n� �to� /,Corp�ny NarPe_ RPORATf4N Contractor Licen�e,[JO� Master Lic. No. (Plant Elect. Only)
u�. � E�.EGI'RK: G4 GA
MailinaAddtes�.�pnt��py p��wne�Pedqr 'puoaJasfa112twn1 , MN 55114
lJS�I KF( L. KS]AU bRlfl 1 M+AUL
Authorized Signature (Cantrector, Compa per Performing In on) Phone Number �
�% � ��'�G"�t"n�c ( ��j s�-zs�t �
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY