P - 81831REQUEST FOR ELECTRICAL INSPECTION
8 O�- 2 6 0� Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-080 � � '�'
�' 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 work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspecfion Fee - This Inspection Request will not be accepted without ihe correct fee:
Other Fee # Service Entranc 'ze Fee # Circuits/Feeders F
Mobile Home Park Stall 0 to 00 Amps .Q() . 0 to 100 Amps ,�
Street Ltg./Traffic Sig. Abo e 200 Amps Above 100 Amps
Tronsformer/Generator INSPECTOR'S USE ONLY TOTALr!
Sign/Outline Ltg. Xfmr. �. �'- JJ • s�
Alarm/Remote Confrol � � � � '
Swimming Pool �°��/�5
I hereb rfi that I ins the electrical insiallotion described herein on the dales stafed
Irri9ation Boom � "• ! � Rough-In Dare
Investigative Fee ��� � w �,
THIS INSTALLATION MAY BE ORDERED D CTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validation date printed in this box.
IIIiIIIIIIIIIIIIIIIIIIIIIIIIII�i�li�ilNllinlll�l ����
* 0 8 0 2 2 6 0 0* �`�
PLEASE PRINT OR TYPE
Request Date Rough-in inzpecfion required? ❑ Yes � No Inspecfion O�er Than RougMn: ❑ Ready Now Will Call�
�—�l— D� (You must call the inspecior when ready) Date Ready:
I, ❑ licensed contractor � owner hereby request inspection of the above elechical work at:
lob Address (Sheet, Box, w R fe No.) Ciy Zip Code
�i�'lvfQ 3 3� e_ �'r i c�, �, 5�a I
Secfion No. Township Name or No. Range No. Fire No. County
nt � � Phone No.
�C�, ,� kG�. -�� -��s�o
upplier Address
� �IC� `.7 - �� V �Si V ■ �
d Conhacfor (Company ame) Conhactor License No. Master Lic. No. (Mant Elecf. Only)
% �
Address �Conkacfor w Owner
�
Signature onhacror or r rfo g I stallation) Phone No.
`��3-cJFs(o-q5'-Ib
1 A-11 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY