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.
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*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