P - 82981REQUEST FOR ELECTRICAL INSPECTION � �
4 5�- 0 6 3 Minnesota State Board of Electricity
1821 llniversity Ave., Rm. S-128, St. Paul, MN 55104
` Phone (612) 642-0800
� Home Duplex Apt. Bldg. Other. New Addn
Commercia) Indushia! Farm Remod Re ir
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: .tr
Dryer Range Elec. Heat Temp. Service
"X" above ihe work coy� red by this re uesi. Enter remarks in pace and on ►he ck of the white copy only.
1..3 � 12,� /� � S � /� �'►'�r'9� � /�-�'1� -- ��'0 /�'!
Calculate Inspection Fee - This Inspeciion Request will not be accepted without fhe correct fee:
Other Fee # Service E�rtrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TQTAL
Sign/Oudine Ltg. Xfmr. � a-
Alarm/Remote Conhol
Swimming Pool
1 hereb certi that I in the el ' I installalion described herein on the dates stoied
Irrigofion Boom R«rgMn - ,�^
Speciallnspecti _ - �
�al . �ale i�r
Invesfigafive F �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� �. . OFRCE USE ONLY This request voi nths from validation dote printed in this box.
IIIIIII 1�15
III II If1 II III II 111 II 111 Il lfl II I11 II 111 I�II
*. � 4 5 i � 6 3 6 * PLEASE PRINT OR TYPE ��,—� ,
R est Dote Rou Itin ins on r uired$ es
/1 9 P�fi eq ❑ No Inspection Ofher Than Rough-In: ❑ Ready No Will Call �
( (`!ou must call the inspec�or when ready) pate Ready.
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at
Job Address (Sheet, Box, or Route* No.� City n Zip Code
�' S � �2tb�C ����:
Secfion o. Township Name w No. Range No. Fire No. Counly
Ocw � Phone No. N O
� N �
Power Supplie, . dress � . � .
Elechicu Contraclor �Compa�ry Name� Contracbr License No. AAaster Lic. No: (Planf Elecf. Only�
U I�1 ��G t C r� c� o`7 6 �
Mailing ress (Contractor or - er Per{orming Inslallafion) .
, � 1 V '� �� �%7l�V l •` .
Au i Signalure (Contractor Owner ming InstallaAon� ��y � Phone No. .
E 1896 � ,"
STATE BOARD COPY - SEE INSiRUOT1pWS ON BACK OF YELLOW CpPY - a ., -