P - 82929REQUEST FOR ELECTRICAL INSPECTION =
6 l.•` 1= 9 8 9� 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 Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the ork covered by this request. Ent r remarks in thi space and on the back of the white copy only.
.�e/��-� /�/,�S'� f ���� �,�.�
Calculafe Inspection Fee - This Inspec►ion Request will nol be accepted 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
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
$ign/Outline Ltg. Xfmr. �
Alarm/Remote Control
Swimming Pool V hereb certi that 1 ins IV�e elechical inslollation described herein on the dWes stated
Irrigation Boom Rough-In �O�
Special Inspec Dare
Final
Investigative Fee c 1'�i1
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months From validation date printed in thit box.
f�������llil�l���������i������������l�l • .
111111 a��
*06079891* 33�b
PLEASE PRINT OR TYPE
Request Dafe Rough-in inspection required$ ❑ Yes o Ins on Other Than Ro h-In:
pecti ug ❑ Ready No Will Call
� — {`:ou must call the inspecicr when ready) Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
lob Add�ess �Sheef, Box, or Route N� / Ci Zip Code
� Q �
. �
Section No. Township Name or No. Range No. Fire No. Couniy
Phone No.
J � Y' ^"
Conhacror (Company Name) . Conhactor License No. Master Lic.
dress (Conhacror or Owner Performing Installation) �
� �' �P �f "�/9"r/� A'/, OC 4�.��� L��� �l� �v� �Z
Signature (Conhactor or Owner erforming Installa' � Phone No.
�5,3��3/
�� 6 STATE BOARD COPY - SEE INSTpUCTWNS ON BACK OF YELLOW COPY