P - 80774REQUEST FOR ELECTRICAL INSPECTION
�' 854-590 []7 Minnesota State Board of Electricity N_
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
, (651) 642-0800 www.e/ectricity.state.mn.us
Home Duplex Apt. Bldg. Other: New Adtln
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 this request. Enter remarks in this space and on the back of the white copy on/y.
NSP SAVER'S S'�M{TCH INSTALLATION
Calcu/ate Inspectic
Jther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransformedGenerator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Po , ,
Irriqation Boom
Fee - This
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I herebvi certiN that I insoected the
be accepted without the correct fee.
�e # Circuits / Feeders Fee
0 to 100 Amps
Above 100 Amps
TOTAL ��;
;drical installation described herein on the dates stated:
Investigative Fee F��� (`,_„�G �f-- ��' Y�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MON HS.
µ�• OFFICE USE ONLY This request void 18 montlis from validation date printed in this box.
I�II�II IIIII I��I) I��II �II�� II�II �� IIII IIII '�
� * a3
08545907
PL
Request Date Rou h-In ins ection re uired? ❑ Yes ❑ Ins ection Other Than Rou
g p q p g- n: ❑ Ready Now ❑ Will 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 A�ddre�ss (Street, Bo�x, o�r�RO�e No.) K�� City F��Y zp c«,a:
REE 56482
Section No. Township Name or No. Range No. Fire No. Counly ��yy� �
/Y�LII\n
� �O S Phone No. �g1Z�74��i.�
Pqyyp�,$ypplier Addrgs�„ S �FF� r�
�v�r nnr•t,.
Electrica� Contractor / Com any Name Contractor License No. Master Lic. No. (Plant Elect. Ony)
r�srER �c�c co., rwc. c��ie�
Mailing Address (Contractar, Company or Owner Pertorming Installation)
i2467 8t'30WE AVE S. SAVA�GE. . 35378 . �1�6i47�7t7 /(B12j8DQ-3lf�
Authorized Signature (Contractor, Comp Performing Installatian) Phone Number
\ �
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY