P - 80701REQUEST FOR ELECTRICAL INSPEC1I�N
��± �� � � � � Minnesota State Board of Electricity ` "
f� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
� � Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm �(��� � Remod
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this requesf. Enter remarks in this space and on the back of the white copy
�
��'� !f0 0 � �� DC%/�' � ��� Se��e1c� (�rr /)/
Calculate Inspection Fee - This Inspection Requesi will nof be accepted withouf the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stail 0 to 200 Amps � j;�va 0 to 100 Amps
Streef Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/�enerator INSPECTOR'S USE ONLY T L
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Conhol �
Swimming Pool
� �����
Fee
I hereb cefi that.l ins the elxhical inslallafion described herein on the da�es stated
irrigation Boom � RougMn "' Date
Special inspection � -
Final Qare /
Investigative Fee - << �� -r
THIS INSTALLATION MAY BE OR�ERED DISCONN D IF NOT COMPLETED WITHIN f8 MONTHS.
OFFICE USE ONLY T17is request void 18 months from validation dafe prinfed in fhis box.
� 11�H II IlI ll lll ll lll il lll ll li�li l� �� l� •�a- 5a
* 0 7 6 5 9 L 0 5* 3�i��
PLEASE PRINT OR TYPE
Request Date c Rough-in 'rnspection required$ ❑ Yes o Inspecfion O�er Than RougMn: Q eady N i Call
�—�� Z �You must call fhe inspecfor when ready) Date Ready:
I, icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Addreu (Sheet, Box, or Route No.) '!: � Zip Code
s-Q�2Y � % r /l/, E �� �Pfi�/e �
Section No. Township Name or No. Range No. Fire No. Couny �
Occupant
!'i e L u
ower Supplier
/l� S, �°
E ical Conhac�or �Company Name)
/e Lcc �
Mailing Address onhacror or Owner
�e/
Phone No.
'�o/-D
Conhactor Lice�se No.
i� ��►c C��ol�2
ming I�stallafion)
��� �r.�. _r- su�t.� � s�,��
or Owner PerFormin Insfallati n Y / Pi
� � �. ,� �
STATE BOARD COPY - I UCTIONS ON BACK OF YELLOW COPY
�/� !'!'l� ss'y3
No.
7S'o-.Sro .?s-