P - 82278.
, REQUEST FOR ELECTRICAL INSPECTION
G� LJ �° 213 � Minnesota State Board of Electriciry
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
Phone(612) 642-0 00
Home Duplex Apt. Bldg. Other �v �� New Addn
Commercial Industrial Farm � � Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heaf Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
�'r��Nt� �v� &�x To C��.eu�-r (32e,qK�2.s
Calculate Inspection Fee - This Inspection Request will not be accepted wifhout 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/Generafor INSPECTOR'S USE ONLY /� TOTAL / r'"]�
Sign/Outline Ltg. Xfmr. �/6 . C4�/ �'a ? r��«Zr wt " �/ •3 �/
Alarm/Remote Control
Swimming Pool
I hereb certi thaf I ins the elechicol insfallafion deuribed herein on the dafes sfa�ed
Irrigation B Rough-In Date
Special ins ,
Final Dare
Investigative Fee /_ Z:b —o'L �p'� > K-e�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request wid I B months from validafion dole printed in this box.
� �II� �� ill �� �I� �I ��� �� ��� �� ��I�H� ��� �� ��� � ���� •/���
* 0 8 0 2 2 1 3 9* i' l��7
LEASE PRINT OR TYPE
Requesf Dafe Rou h-in ins ecfion re uired?
g p q ❑ Yes No Inspection Other Than RougMn: ❑ Ready Now Will Call
? a6 D a (You must call the inspecfor when ready) Dafe Ready:
I, ❑ licensed contractor � owner hereby request inspection of the above efechical work at:
lob Address f5hcef, Box, or Roule No.) Cily Zip Code
97 � �'; �L �a L �'
Section No. Township N^me or No, Ran�No.� Fire No. Counly �
OccupaM Phone No. -� T
�N�iRZES GN� -��
Power Suppfier Address
N s P J�l PLS /ti `D vts �c
Elechical Confmc r(Com ny Name) : Conhocfor License No. Masfer Lic.
��N�erZ. 2824 Q
Mailing Address (Conhacfor or Owner Performing Installafion)
�- sf�r�e �-
Aufhorized Signature �Cg�yrqepr or Qwirer Performing InstallaTion) phone No.
1 A-11 8/96 �p� gOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY