P - 82513REQUEST FOR ELECTRICAL INSPECTION
8 tJ �° 2 3 3 0 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 -
� Phone(612)642-0 00
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.
Rt `u5� -�-ktS ��h q ciy-cv�1'' �'a� y�zt.� Grepia.ccw��-�'�'�
✓
a� r�.� ��� � a��.� �,
Calculate Inspection Fee - This Inspection Request will not be accepted without ►he correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall O to 200 Amps 0 to 100 Amps
$treet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TQJ�TAL�
Sign/Outline Ltg. Xfmr. � �� i� eG �
Alarm/Remote Control � v
Swimming Pool
I hereb certi Ihaf I ins the elechical insfailation dexribed herein on the dafes slafed
Irrigation Boom Ro„gM„
Special Inspection ^ �'_ �'!
Final � Dal�-� f
Imestigative Fee a - /
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This requesf void 18 months from validafion dafe prinfed in fhis box.
��II�����II��I����I�I�II�I���I�H�lll���l�l �� aq ��,.: •
* 0 8 0 2 2 3 3"°' �� ��`� ��i ��•�
PLEASE PRINT OR TYPE
Request Date Rough-in inspecfion required? ❑ Yes ❑ No Inspecfion Other Than Rough-In: ❑ Ready Now �Wil) Call � .
I,� 2^^ 0�% (You must call the inspecror when ready) Date Ready:
i, ❑ licensed conhactor � owner hereby request inspection of the above elechical work at:
Job Address (Sheet, Box, or Route No.) Ciy Zip Code
S�o 5��' ,�vc F^�d 1�Y 5sy'3�.,
Secfion No. Township Name or No. Range No. Fire No. Couny
Occ�nf
r�a�
Power Supplier
Elechical Contracror
Sc� 1.�+ ^e_
Mailing Address (C<
Authorized Signatun
8-00001 A-11 8/9!
18�. I �t-k �.-Z. . �
or Owner
w
/ /' !/j Q% � �'
Phone No.
�G3 -S?a-`f�'1�
License No.
�
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
l`�