P - 82622� _�., ,� � � REQUEST FOR ELECTRICAL INSPECTION ��
��� O 9 Minnesota State Board of Electricity �
1821 University Ave., Rm. S-128, St. Paul, MN 55104 � ;
Phone (612) 642-08 0 �����.
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Home Duplex Apt. Bldg. Other/ �
Commercial Industrial Farm � � New Addn
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: Remod Re air
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space ond on the back of the white copy only.
Calculate Inspeciion Fee - This Inspection Request will not 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 TOT L
Sign/Outline Ltg. Xfmr. / `�
Alarm/Remote Control �� e� L/ � � ���� '�
Swimming Pool
Irrigation I hereb certi that i ins ected fhe elecfrical installafion described herein on the dafes stated
RougMn pO}e
Special In c '
Investigative Fee F'"°I
–(-z._QZ oore�+� /��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHI 8 MONTHS.
OFFICE USE ONLY This request void 18 months from validation dafe printed in this box.
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PLEASE PRINT OR TYPE r
Requesf e Rough-in inspection r uired? Yes
/� e9 ❑ No Inspection Other Than Rough-In: ❑ Ready Now Will Call
rl� `'�(� (l'ou must call fhe inspector en ready) Date Ready:
I, ❑ licensed contractor owner hereby request inspection of the above electrical work at:
Job Add��e�ygpx or Ro�No.' — �
� ' C�h' Zip Code
G S 9 e�C �!' !.C) L�� ,3a
Section No. Township Nam�No. Range No. Fire No.
� Couny
Occupant �v' `^ �
Phone No.
S�� hen 1`t1� ue�ro -C_ SG6-397.5—
Power Supplier� s w Addres� /�
i�1% /f L, /I/_ A l
Mailing
ny rvame� � v ( 7 A
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or Orn� Performing Insfallafioni
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No. Masfer Lic. No. (Planf
��nwnze ai norore Conhacfor or , ner � ing Insfollotion�
� - Phone No.
-0OOOIA 11�8/q6 ,�66 3 9 7S�
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPV