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P - 81188REQUEST FOR ELECTRICAL INSPECTION 0-854-615 []2 Minnesota State Board of Electricity � ,� 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 - - (651) 642-0800 www.e/ectricity.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" above the work covered by this request. Enter remarks in this space and on the back of the white copy oNy. NSP SAVER'S S\MTCH INSTALLATION Calcu/ate Inspecti� �ther Installations Mobile Home Park Stall Street Ltg. / Traffic Sig. Transformer/Generator Sign / Outline Ltg. Xfmr. Boom Fee - This Inspection Request will not be �e # Service Entrance Size Fee 0 to 200 Amps Above 200 Amps INSPECTOR'S USE ONLY � Investigative Fee � � THIS INSTALLATION MAY BE I II Illl I I I I I I III I I Il Il II II I 11111�11I� � I� *08546152* In without the correct fee. Circuits / Feeders 0 to 100 Amps Above 100 Amps TOTAL herein on the dates stated: �' � �a'�— �` °� � IE ONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. OFFICE USE ONLY This request void 18 montlis from validation date printed in this box.�� i °� �$c 7s�� Request Date Rough-In inspection required? ❑ Yes ❑ I Inspection Other Than RougF�}n: ❑ Ready Now ❑�11 Call �,�� You must call the inspector when ready� Date Ready: �ti �i�a I, [�icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: JoJ�c�Ss (Street, �t gq��,[yo�� City ���Y Zip Code�.��2 I 7:31J I�R'�(,JN Section No. Township Name or No. Range No. Fire No. County �A 7Ztl67 ri[v'yd �. Phone No. fQ+�•Z�'��7Z �v �����LS'���� n an Name Contractor License No. Master Lic. No. (Plant Elect. Only) "�C Ci3.. iNC. CA011A2 or, Company or Owner Performing Installation) �12 1-4712 I 812 33� AVE S, SAVAGE. MN. 55378 i � � �- � ny or Owner r�i IpfslaY�ion) Phone Number � � �11 /+r' � � EB-00001A-12 5/1 99 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY