P - 82089E
w REQUEST FOR ELECTRICAL INSPECTION
O%859-816 1� Minnesota State Board of Electriciry
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
' {651) 642-0800 www.electricity.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 ihe back of the white copy only.
NSP SAVER'3 SWITCH
Ca/culate Ins ecHon Fee - This lnspection Request wi!! not be accepted ovithout the correct fee.
Other 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
TransformeNGenerator INSPECTOR'S USE ONLY TOTAL
Sign / Outline Ltg. Xfmr. ��'
Alarm/Remote Control � �
Swimming Pool
I hereby certi that I inspected the electrical installation described herein on the dates stated:
Irrigation Boom Rough In Date
Speciallnsp iqrFr
lnvestigaYive e e• Flna� Date �/��
� G
__.__ _._. __THIS, INSTA�LATION MAY.BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request wid 18 monms from validation date printed in this box.
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*085981 61 * a��3
PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? � Yes ❑ Ins
f� pection Other Than Rough-In: �ieady Now ❑ Will Call
You must call the inspector when ready! Date Ready:
I, �] licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route Na.) Ctty Zip Code:
Section No. Township Name or No. Range No. Fire No. Couniv
Occupant ^� ���
aABEL JANIE M
Power Supplier Address
N�P - � �r�� u
Electrical Contractor / Company Name
Mailing Address (Contractor, Company or
2300 TERRITdRIAL R�
Authorized Signature (ContracTOr, Compar
EB-00001A-12 5/1999 _ — �
or Owner
STATE BOARD
---- NR�1
Phone No.
License No. Master Lic. No. (Plant
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Number