P - 80795E
, REQUEST FOR ELECTRICAL INSPECTION
��-854-644 a Minnesota State Board of Electricity - _
1821 University Avenue Suite S-128, Saint Paul, Minnesota 5510A-2993
' (651) 642-0800 www.electricity.state.mn.us � : - '
Home Duplex Apt, Bldg. Other: New Addn
Commercial IndustriaV Farm Remod Repair
Air Contlitioner Htg. Equip. Water Htr. X Loatl Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
'X" above the work covered by this request. Enter remarks in this space and on tne bactc ot tne wn�re copy orny.
NSP SAVER'S SWITCH INSTALLAT]ON
Ca/cu/ate Inspection Fee - This Inspection Request will not be
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransformedGenerator
Sign / Outline ttg. Xfmr
AlarmlRemote Control
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
without the correct fee.
�ircuits / Feeders
0 to 100 Amps
Above 100 Amps
TOTAL �,
. .............y . .._.
I hereb certi that I ins ed the electrical installation described herein on the dates state :
Irrigation Boom Rough In D&te -
x Special Inspection 1S.{� ��
Investigative Fee � ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
____._...___._..._._._._..,,_,,_ ».-..... pFFICE USE ONLY This request void 18 months hom validation date printed in this box.
f 111111 IIIII Illll Illll Ifl� IIIII IIIYiI�I I�I Inl ��-�
*08546442* ���9
Request Date I Rough-In inspection required? ❑ Yes ❑� I Inspec[ion Other Than Rougll-J�: ❑ Ready Now ❑ Will Call
�i,�,�� You must call the inspector when rea Date Ready: ��
I, [jQicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Joh��iLg,�,s (Street, B r t IJp� �� City �d�Y Zip Code:
U .'il0 t.�U �M 5�421
Section Na. Township Name or No. Range No. Fire No. County A1.v1�t w
�YR�►V1
O� Phone No.
�.Q �.
PpW�,$�pplier . Addr s
�`r�+"� �'t.S QFFI CE
Electrical Contractor / Com an Name Conuactor License No. Master �ic. No. (Plant Elect. Only)
NIASTER ELEC�C CO.. tf�'. CA099�2
Mailing Address (Contractor, Company or Owner Performing Installation)
124�'7 �ClI�� AVE S. AGE. WW. 55378 {�12�41�-d7121 (812�-35fi6
Authorized Signature y or Owner Perfarming Installation) Phone Number
\ 1
EB-00001A-12 5/199 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY