P - 80794REQUEST FOR ELECTRICAL INSPECTION
O_854,_6'4,% � Minnesota State Board of Electricity 3
1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.e/ecfriciry.state.mn.us : `
Home Duplex Apt. Bldg. Other: New Addn
Commercial Intlustriai 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 oi the white copy only.
NSP SAVER'S SSIMTCH INSTALLA714N
Caiculate inspection Fee - This lnspection Request wil/ not be accepted without the correct fee.
Uther Installations Fee # Service Entrance Size Fee # CirCUits / Feeders Fee I
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 Poo
Irrigation Boom i nereb certiy that I inspected the electrical installation described herein on the dates stated:
Rough In Date
x Special Inspection 1S.�i
Investigative Fee ��� ° r2 �� 9
THIS INSTALLATION MAY BE ORDERED D ECTED IF NOT COMPLETED IN 1_�A�J��,.__w
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OFFlCE USE ONLY This request void 18 months from validation date printed in this box.
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Request Date Rough-In inspection required? 0 Yes ❑ Inspeciion Other Than Rougtp}n: � Ready Now 0 Will Ca11
,�,,,.�,,,,,�,., You must call the inspector when ready� Date Ready: �L ,�,�..,,,,,�,�
I, (]Qicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
J�1��� �s«�t, �L�.��EN DR
Section No. Township Name or No. Range No.
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Electrical Contractor
aAAS7ER Et
RRY 8
, iNC.
c�`� FRILX.EY `�
Fire No. County �A
Phone No.
Addrg �., S ��� .�
M"l+
Mailing Address (Contractor, Company or Owner Performing Insta
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Authorized Siqnature ( , Y or Owner Performing
EB•0OOO1A-1 1999 STATE BOARD COPY
Contrector License No. Master Lic. No. (Plant Elect. Only)
CA01/02
� (Q12j941-0712 ! (812j�1-3555
�� Phone Number
SEE INSTRUCTI�NS O�BACK OF YELLOW COPY