P - 81165REQUEST FOR ELECTRICAL INSPECTION
O��CJ8'31 8 � Minnesota State Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.elecfricity.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 Efect. Heat Temp. Service
'X" above the work covered by this request Enter remarks in this space and on the back of the white copy only.
N3P SAVER'3 3WtTCH
Calculate Inspectii
Jther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irrigation Boom
Fee - This lnspection Request will not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
� rrerebvi certirv rhat � insoected tne elecvica�
without the correct fee.
Circuits / Feeders
0 to 100 Amps
Above 100 Amps
described herein nn the datss stated:
� � Investigative F�e+ � J�� �,% �' '°' � _�/ ��'°� ��-� d'L�
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THIS INSTALLATION MAY BE Q�ip�R��.��rT��•'�••"'�'�T �""' �""""°��
................................
pFFICE USE ONLY This request void 18 montlis from validation date printed in this ox.
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* 0 8 5 8 3 1 8 9* PLEASE PRINT OR TY
R�� Rough-In inspection requi�ed? ❑ Yes ❑ No Inspection Other Than Rough-In: (� Ready Now ❑ Will Call
You must call the inspector when readyl Dafe Ready:
I, ❑ licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
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Job Add�et, eoX, ��► gT �E FRIDLEY
Ran e No. Fire No. Counnw�1�1
Section No. Township Name or No._�.�__�_M 9 P�`�
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Signature
Fa_nnnolA-12 5/1999 STATE BOARD COPY
Contrector Lice
Phone No. ___.„
Master Lic. No. (PIaM
MN 55114
��� Phone Number
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SEE INSTRUCTIONS ON BACK OF YELLOW COPY