P - 80783REQUEST FOR ELECTRICAL INSPECTION
�-854-581 � Minnesota State Board of Electricity F- .
` 1821 University Avenue Suite S-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 only.
NSP SAVER'8 SIMTCH INSTi4LLATIC?N
Calcu/ate Inspecti<
�ther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sian / Outline Lta. Xfmr.
Fee - This Inspection Request will not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
without the correct fee.
Circuits / Feeders
0 to 100 Amps
Above 100 Amp�
TOTAL '
y certity that I inspected the electrical installation described herein on the dates
In Date
.sa
A Special Inspe i 1O•�
Final Date 8,
Investigative � (
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
u��LL.���x4.YwLL.LL.4�W W�W W W� Y.� W�.y W Y.�.4w OFFICE USE ONLY This request void 18 moniFis from validation date printed in this box.
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08545816
P�e�a��
Request Date Rough-In inspection required? ❑ Yes � yp Inspection Other Than Raugl�n: ❑ Ready Now ❑�II Call
�1�g You must call the inspector when readyT � Date Ready:
I, [7fQicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Jab�Addeoas (Street, � v ou icN ST' 1� °itj FRlQLEY zip c��5492
� --
SecUon No. Township Name or No. Range No. Fire No. County
P�upplier
W�� ,�, T Phone No.
Addr�s �F��
, iNC.
EB-00001A-12 5/1999 ��// STqTE BOARD COPY
Master Lic. No. (Plant Elect. Only)
. �_ ,��12j941-Q?121 (Q'l2j8�3-'�
Phone Number
�"7�43 ( )
SEE INSTRUCTIONS ON BACK OF YELLOW COPY