P - 84590� REQUEST FOR ELECTRICAL INSPECTION
4 5'iJ �/� /� /� Minnesota State Board of Electricity
� �� `f `� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Indushial Farm Remod
Air Co Htg. Equip. Water Hfr. 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
go6 C � 77-7885
Calculate Inspection Fee - This Inspection Request will not be accepied without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic $ig. Above 200 Am s Above 100 Ai
Transformer/Generator INSPECTOR'S usE oN�v TOT�
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�e r
=�1: .
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Fee
Sign/Oudine Ltg. Xfmr. �Jr, fJ�
Alarm/Remote Conhol
Swimming Pool
I hereb certi fhaf I ins ihe elecfrical installaHon described herein on fhe dafes sfated
Irrigation Boom Roo91�1„ oare
_THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This requesf void 18 months from validation date prinfed in this box.
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* 0 4 6 5 4 4 4 8�k PLEASE PRINT OR TYPE
Request Date Rough-in inspection required? ❑ Yes o Inspection O�er Than RougMn: ❑ Ready Now ill Call
5�� ���% � (You musf call the inspector when ready� Dafe Ready:
I, �licensed confractor ❑ owner hereby request inspection of the above electrical work at:
Job Addreu (Sfreet, Box, or Roufe No.) City Zip Code
(o O J�' ?`�h �Z � ��o�. ��2 S t� �S a--
Secfion No. Township Name or No. Range No. Fire No. Cou
J� r10 kD�--
� "' ' � �� Phone No.
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Power Supplier Address
Elechiml ConQ, ���Company Name�^ C, �. 'NC. Contracfor License No. Master Lic. No. �Planf Elect. Only)
o�M�\ �Q I+IV GLGV � �
ti� .�aa� avE_ �_F_ ClR O!?q lo
errormm� msmnanon� Phone No.
��,6„� ��I�� 757—(0��0
BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY