P - 832976���027 �
Home Duplex
Commercipl Industri
Air Cond. Htg. Ec
Dryer Range
"X" above the work covered
REQUEST FOR ELECTRICAL INSPECTION �
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, fviN 55104 �`
Phone (612) 642-0800
Apt. Bldg. Other: New Addn
Form Remod Re air
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this space and on the back of the white copy only,
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Calculate lnspeciion Fee - This lnspec� n quest will not be occepted without the correct fee:
Other Fee # Service Entrance 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 oN�v TOT L /�
Sign/Oudine Ltg. Xfmr. • ��J
Alarm/Remote Control
Swimming Pool
I hereb cerfi that I ins ed the eleclrical installation described herein on the datas stared
lrrigation Boom R�9�� p�e
Speciallnspection � d
Investigative Fee � � - 3 c� — �
THiS INSTALLATION MAY BE ORDERED DI CONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date prinfed in fhis box.
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PLEASE PRINT OR TYPE
Request Daffi � Rough-in inspection required? ❑ Yes
�� � ❑ No Inspection Other Than Rough-In: Ready Now 0�II Call
(You must ca(I the inspector when ready� Date Ready:
I, icensad conhactor ❑ owner hereby request inspection of the above electrical work at:
Job dd�ss (Sheei, Box, or Route No.� Cify � - -/� Zip Code /`
/ � � � �' Ml c // ��
xcnon rvo. iownsnip rvame or rvo.
Occupant
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Power Supp ier � � A
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��E�`A`�L�'"�L��'�Rl
�c,a [���n Raoids Blvd. NW
No. I Fire No.
Phone
Sigrwture actor or Owner Performing Insfa ' n� �� V V lJ � Phone No.
�s7�s�ld
11 8/96 STATE A D OPY - SEE INS7RUCT10NS ON BACK OF YELLOW COPY