P - 81069.
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REQUEST FOR ELECTRICAL iNSPECTION
Minnesota State Board of Electricity -
1821 Universiry Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electriciry.state.mn.us : -'
'X" above the work covered by this requesL Enter remarks in this space and on the back of the white copy only.
NSP SAVER'S 3WITCH
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
- This Inspection Request will not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
withouf ihe
Circuits / Fee
0 to 100 Ar
Above 100
I herebv certiN that I insoec[ed the electrical installatlon described herein an the dates stated:
Investigative Fee ' ��� ��s- I��= 2� 6,� I
THIS INSTALLATION MAY BE ORDERED DI � NECTED IF NOT COMPLETED WITHIN 18 MONTHS. �
�--� - � - ---- - --- -
-...... �.........»...... _..� ....................� ...... _.............................. -.......... ..... _.._. _... _ �. _....� m �... �.... _. _. _.� _.......,.�.�'
OFFICE USE ONLY This requ�t void 18 ma�tlis from validation date printed in this box.
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*08583395* ��%
PLEASE PRINT OR TY
Re�g�J.�tg,_ Rough-In inspection requiretl? � Yes ❑ No Inspection Other Than Rough-In: � Ready Now ❑ Will Call
.� �a�� You must call the inspector when ready! Date Ready:
I, ❑ licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
.� a�`�r ee', B°", �Ea ST NE °itj �RIDLEY �P �
Section No. Township Name or No._._�.� Range No. Fire No._�� Couni�a���VA
--- T�I�tir1Yti
Occupant ��yN� �p� E Phone No. M__
......... . �..... ..,.....�.. ..,�... ,
Authorized Signafure (Contractor, Company or Owr
��u �.j F,
EB-00001A-i2 5/7999 STAI
Contractor Licen� �6� Master Lic. No. {Plarit Elect. Onty)
W4W
`�i��' , MN 5�'114
ingYn on) Phone Number
�� �'la�+a� ( es� e�s-zsT�
COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY