P - 80770/� �
REQUEST FOR ELECTRICAL INSPECTION �` °
�J-854-594 90 Minnesota State Board of Electricity __ ��a
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
� (651) 642-0800 www.e/ectricity.stafe.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 this request. Enter remarks in this space and on the back ot tne wnite copy onry.
NSP SAVER'S SWITCH INST'ALLATION
Ca/cu/ate Inspectic
�ther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransformedGenerator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irrigation Boom
Fee - This Inspection Request will not be
:e # Service Entrance Size Fee
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I herebvi certiiv that 1 insoected the electri
without the correct fee.
Circuits / Feeders I
0 to 100 Amps
Above 100 Amps
TOTAL �
�n described herein on the dates
Investigativ e ,�' ;. �"a� �� I uac� Z 3^o � I
THIS INSTALLATION MAY BE ORDERED DISC ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
���W �W W _ .Y W��_W W�w W�YW W�� y W Y•�wOFFICE USE ONLY This request vad 18 months from validation date printed in this box.
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*08545949*
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Request Date I Rough-In inspection required? ❑ Yes ❑ N�+ I Inspection Other Than RougF�n: ❑ Ready Now ❑ Will Cell
�,� � Yau must call the inspector when ready�� � Daie Ready: ��
88�1�
I, �icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Jo�rp.�, (Street, �,�goy�� �R � City ��Y zP ����
Tu c:
Section No. Township Name or No. Range No. Fire No. Counry �
��'RA J0�'.�EPH J
Paww.6upplier Addr�sg.,. S ���
IV�' IVR"L
e i�agpj/� �;yfjam,grt"t�, Contrecto�L�rt�
CL.t{,� i t�Ci t; �v v
Mailin Address (Contractor, Company or Owner Perfo�ming Installation)
92�67 BQOfVE AilE S. SA��QE. MN. d�378
Authorized Signffiure (CoMractor, C Owner Performing In
EB-00001A-12 5/1
��'3
STATE BOARD COPY
Phone No. �6,���q�nQ�e
LV�7o
Lic. No. (Plant Elect. Onty)
(8'l2�44-4?12! (8'12�9D-3�5
Phone Number
c�
SEE INSTRUCTIONS ON BACK OF YELLOW COPY