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P - 81189REQUEST FOR ELECTRICAL INSPECTION � 0'C.754_6�9 � Minnesota State Board of Electricity - _ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 (651) 642-0800 www.electricity.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 Elect. Heat Temp. Service x�� anove tne work covered by this request. Enter remarks in this space and on the back of the white copy on/y. NSP SAVER'S SVNITCH INSTALLA170N Calculate Inspecti� Dther Installations Mobile Home Park Stall Street Ltg. / Traffic Sig. Transformer/Generator Sign / Outline Ltg. Xfmr. Irrigation Boom Fee - This lnspection Request will not be :e # Service Entrance Size Fee 0 to 200 Amps Above 200 Amps INSPECTOR'S USE ONLY I herebvi certi(v that I without the coirect fee. Circuits / Feeders 0 to 100 Amps Above 100 Amps TOTAL , Date � � Investigative Fee � � L� "° -S= zz `�( � THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. . . . . y.................................,.. ..........................._........_._,.._.......�,_..._.��.Rm,.,..,.._._,.. OFFICE USE ONLY Thia request vdd 18 rtaMhs trom validation date printed in ihis box. � ������ ����� ����� ����� ����� ������II �� � ao - 5� *08546095* 7�� P�61�AIYN�R�l990E000 Request Date Rough-In inspection required? ❑ Yes ❑ Inspection Other Than Rougl�,ln: � Ready Now ❑ Will Call �,�� You must call the inspector when ready� Date Ready: �� I, [aGicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: JojZQd�,�s (Street, �Q�,O}t�jg tu �)�� � City ��.y � Zip Codr�A�� iR3i lU � ( �1t1_i `- r :iw Section No. Township Name or No. Range No. Fire No. Counry � Oo�e�ef��w wA, � g Phone No. �Q�n����,� �r7nlGi«V'\ �,�h �l L L�YYi� � �c�c co.. �NC. Address (Contractor, Company or Owner Perfo B7 BOOA� AVE S.�SAVAGE, !ed Signature (Contractor, Com or ner I EB-00001A-12 5/1999 ��� STATE BOARD COPY Master Lic. No. (Plant Elect. Only) �892�47-07121 (61Zj89�-3� Phone Number \ / SEE INSTRUCTIONS ON BACK OF YELLOW COPY