P - 81187" REQUEST FOR ELECTRICAL INSPECTION �"� "
` 0-854-623 06 Minnesota State Board of Electricity _
!� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 -
(651) 642-0800 www.electriciry.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 on/y.
NSP SAVER'S SWITCH INSTAUATION
Ca/cu/ate Inspection Fee - This Inspection Request will not be accept
nstallations Fee # Service Entrance Size Fee #
Mobile Home Park Stall
Street Ltg./ Traffic Sig.
TransformedGenerator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
without the correct fee.
Circuits / Feeders
0 to 100 Amps
Above 100 Amps
TOTAL ,
� Investigative Fee � �""" � _��_ �— - �"°� L;-° J �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
...................._�_..._...,..-..................,..-........................................,........_........�............_...........�._... - -- - --
OFFlCE U� ONLY TMs requ�t void 18 months from validation date printed in this box.
IIIIIII�II���III�IIIIII�I�III�III��I� � �O'�
*08546236* ���
PLG�AN�Y���O
Request Date Rough-In inspection required? ❑ Yes ❑ Inspection Other Than Rougluln: � Ready Now � Will Call
08112/l�Si
You must call the inspector when read� Date Ready: 1� Me���
I, []Oicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
JaipQ�@;s (Street, illiiY tfiRCtii «i� (� C� ��� �P ��3
urcx��t
Section No. Township Name or No. Range No. Fire No. County � �(A
Mailing Address (Contractor, Cort
72Q67 QOOIrE AVE
Authorized Sianature (Contrac:tnr_
R08ERT D
Addrp�� s ���
P�A"L
�.. ��uc. �
or Owner Performing Installation)
S�4VAGE. A�V. 55378
EB-00001A-12 5/1999 �� STATE BOARD COPY
Phone No. �s�.�t7��Q
� �,
1Qo.� Master Lic. No. (Plant Elect. Only)
(ltf2�41-47t2! (Q12j8�-33'3'.S
Phone Number
� /
SEE INSTRUCTIONS ON BACK OF YELIOW COPY