P - 83300REGIUEST FOR ELECTRICAL INSPECTION
����= 9 4 4� Minnesota State Board of Electricity
-
, 1821 University Ave., Rm. S-128, St. Paul, MN 55104 .�:
.� Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New Ad
Commercial Industrial Farm Remod e air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this requesi. Enfer remarks in fhis space and on fhe back of ihe white copy onfy.
O Ue �-d�t,QO TO (,� �o /J? e f cn C f��,e�C'�
Calculate Inspection Fee - This Inspection Request will not be accepted without fhe correci fee:
Other Fee # Service Entrance Size Fee # Circaits/Feeders Fee
Mobile Home Fark Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Tra�fic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTA���
Sign/Outline Ltg. Xfmr.
Alarm/Remote Confrol
Swimming Pool
I hereb cerii that I ins ected the electrical installafion described herein on the dates stated
Irrigation Boom Rough-In Dore
Special lns
Investigative ee F���� �6 -� =-�
THIS lNSTALLATlON MAY BE ORDERED DISCONNEGTED IF NOT COMPLETED WITHIN �8 MONTHS.
OFFlCE USE ONLY This requesf void 18 months 6om validaii9ydaTe�� inted in this box.
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PLEASE PRINT OR TYPE
R uest Dafe Rough-in inspeclion required$ ❑ Yes o Inspecfion O�ar Than RougMn: � Ready Now ill Call
��� f� (You must call the inspecfor when ready) Date Ready:
I, icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sfreet, Box, or'noute No,� City • Zip Code
� a� ��o�� St,v� �,��d��
Section No. Township Name or No. Range No. Fire No. Co
Occupanf Phone No.
. � / A-S 0 Ai
Po er upplier Address �
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Eleckical Conhacfo��Company me) � Conhacror License No. Master lic. No. (Plant EIeM. Only)
i. ITQ ¢ c,T C�¢ Ol
iling Address �Conhacror Owner Performing Insfallation� �
- /n/�iv ' 'L �O G�(i�'� G
Auf oriz ' na re ( hactor or er P ing Installafion) Phone
65 6 ��-�1��'
EB-00001 -11 8/96 TE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY