P - 81028✓
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Commercial
Air Cond.
Ra
"X" above the work coverec
/ - �-
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 =
Phone (612) 642-0800
Farm / � � ' � � -
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
�i�equest. Enter remarks in this space and on th�ck of the
� e
New
Remod
copy only.
Calculate Inspection Fee - This Inspection Request wiN rof be accepted wifhout the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./TrafFic Sig. Above 200 Am s Above 100 Ar
Transformer/Generator INSPECTOR'S USE ONLY ��� �t TOT�
$ign/Outline Ltg. Xfmr. �tc=��,,i,�y� �
Alarm/Remote Conhol '�Qcar�.- !1� 8��� (2- �'7l �)
Swimming Pool
I hereb cedi t6at I ins ed ihe el al installafion described herein on the date
Irrigation Boom RooaMn � �,
Fee
�S�
Investigative'*@e�• '* , ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN � MONTHS.
OFFICE USE ONLY ihis request void 18 monfhs from validation dafe prinfed in tFiis box.
Illlllllllllllllllllllllllllll�l���l� � /_��5d
* 0 8 0 2 1 5 4 5* tp�Jt��
PLEASE PRINT OR TYPE
Requesf Dafe RougfFin inspection required? Yes ❑ No Inspecfion Ofher Than Rough-In: ❑ Ready Now Will Call
Q� �You musi call the inspector when dy� Date Ready:
I, ❑ licensed conhactor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheef, Box, or Route No.� Cily � Zip Code
?� ,�.�� Srt �r��% 55�a/
Section No. Township Nome or Range No. Fire No. Coun �
�O � � N d I�C0. ,
Occu nt � . . Phone No.
�c�a,-ci t Le 61z' S`%� - QS''
Power Supplier ` � � _ Addr � � � �a �� � /1 ! � �
�I/!Il .S �
Eleclriml Conhactor f�oyRany Name) Conhacior License No. Master Lia. No: �Plant Elecl. Only�
Mailing Address (Contractor
or Owner Performi nslollat`pn) �j �� �� F rnone rvo.
�t, �-�c�sz �" ! 5 7a 8i�
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY