P - 82333REQUEST FOR ELECTRICAL INSPECTION
O�d � o��� � Minnesota State Board of Electricity
0"� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
�`
Phone (612) 642- 800�
, Home Dup�ex Apt. Bldg. Other) �� ra l New Addn
Commercial Industrial Farm [' j�i mod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Requesi will not be accepied wifhout the correct fee:
Other Fee # Service Entrance Size Fee # Circuits
Mobile Home Park Stall 0 to 200 Amps 0 to 100 A
Street Ltg./Traffic Sig. Above 200 Am s Above 100
Transformer/Generator INSPECTOR'S USE ONLY
Sign/Outline Ltg. Xfmr. � _�bi,.��
Alarm/Remote Control � �
Swimming Pool
I hereb certi thaf I ins the elechical installafion described 'n
Irriaation Boom o�.,.�.. �
Fee
�� 3�
apeciai insp �,� f- - ' � "�� /�
Investigative Fee
� F� �/�.�G
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 1 MONTHS.
�FICE USE ONLY This request void 18 months from validafion date prinfed i� ihis box.
Iilllllllillllllllllliliillll�lllllll�il�l �� �3� • ���
* 0 8 0 2 2 1 7 0�
PLEASE PRINT OR TYPE
Reques� �'�� Rou ffin ins fion r uiredZ ❑ Yes
g pec eq ❑ No Inspection Other Than Rougffln: ❑ Reody Now � Will Call
( (You must call the inspeclor when ready� Da�e Ready:
I, ❑ licensed contractor � owner hereby request inspection of the above electrical work at:
Job Address (Sheef, Box, or Roufe No.� Cily Zip Code
Z � 1 �'c � � 2/
Section No. Township Name or t�IQ. Range No. � Fire No. County
Occupanf
��.�w ��
Power Supplier
/11J' 3°
Electrical Confracfor (Company Name)
( �t�''�-/ ��
Mailing Address �Contracfor or Owner Performing
� � �
Aufhorized Sinna re IContracfor or Owner Perfori
)�/� 4��
Address
��
Conha�
<<
�
r
Phone No.
76 �-,s- � Z
� f/l� /��
���
�