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