P - 80787,,
, Q-854-649 1[]
REQUEST FOR ELECTRICAL INSPECTION
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. Loatl Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
X" a6ove the work covered by this request. Enter remarks in this space and on the back of the wnite copy orny.
NSP SAVER'S SiMTCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee.
�ther Installations Fee # Service Entrance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming P
I hereby certity that I ins ed the electrical installation described herein on the dates stated:
Irrigation Boom peuoh In Date
Investigative Fee Fi"'� ��c — I uaJ _Z .L_� I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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OFFICE U� ONLY This request void 18 months from validation date printed in this box.
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Request Date Rough-In inspection required? ❑ Yes ❑ Inspection Other Than Rougf�-}n: � Ready Now ❑�II Call
You must call the inspector when ready� Date Ready: ��
I, [jQicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
�o���l� iStreet, TAYL�UKN� (� °i�' ��y Zip Code:
55421
Section No. Township Name or No. Range No. Fire No. CouMy �
�1�I�
� GfiRl �..
Addrgs�,,,, S ���
IYR'�L
31 Contractor / Com Name I Cc
�''TER"' ELEG"�C C�., IIVC.
Address (Contractor, Company or Owner Performing Installation)
g� e�n� avE s, snvAC�, a�v, �s�s
�ed Signature (Contractor, Com r Performing Installation)
EB-00001A-12 5/199��� STATE BOARD COPY
Phone No.
Lic. No. (Plant Elect. Only)
�612�941-47121 (012�3-3555
� Phone Number
• � /
SEE INSTRUCTIONS ON BACK OF YELLOW COPY