P - 81387� IN,pf� II RE�UEST FOR ELECTRICAL WSPECTION a�€`��.....
' II�IIIIIIII I(I IIII ry II I I(I III III Minnesota State Board of Elechicity ���°:,
, �� 1821 University Ave., Rm. S-128, St. Paul, MN 55104 � �-
* 0 3 9 2 0 9 2 3* Pho�elsi2�saz-oaoo `"����-
Home Duplex Apt Bldg. Other: New Addn
itl. Htg. tquip. Water Htr. v Load M9m�� O}her
Range Elea Heat Temp. Service
the work covered by this request. Ente� remarks in this space and ar the back of the white copy onty.
SAVEk'S :;WITCH ZNSTALLATION
/nspectbn Fee - This Inspecfion Request will not be acceptetl without fhe conect /ee:
Other Fee � Service Entrence Size Fee � Circuits/Feeders Fee
le Home Park Stall 0}0 200 Amps O to 100 Amps
=t Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
�former/Generator INSPECTOR'S USE ONLV TOTAL
�Outline Ltg. Xfmr. �,, : �p
n/fiemote Control
�'�'�� ��� ��� �� �� � ` I hereby oehlty �hat I inspec[ed the elech�cal irstalla�ion rlescnbc-0 herein on ihe Cetas s�atad
Irrigation Boom � qousn-i� oate
X Special lnspection 1. S�i
Final
InvestigativeFee -� °�_ Zz -�%
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
'OFFICE USE ONLV This raQUas� voitl 18 months fmm v�Jltla�lon tlate primed in this bw.
392-09� •�a615 5a
,7GF3 NuT"iiic:ii 3198PJ6�tE%�'
PLEASE PRINT OR TYPE
RequBS��a{� ��,�� Rougo-in inspeotion requiretl? O Ves f]NO Inspection Other T�an Rough-Iti 6L Heatly Now O WiII Call
1 / T 7f
lYa, must caII1M1e Inspecior whEn reatly� Date ReadY'� � r
I, `�] licenaed conhactor ❑ owner heraby raques� lnspectlon oi the ahove electrlcal work at:
.bb Address (Siraet, Box, or Roule No) Ctty Zlp Gode
�5£t00J STH S7' NE PRIULEY �_�4:�2
Sect'pn No_ Township Name or No_ Rar�ge Nn Ftre No. Gourry
ANCJKk
Occupant Phone No.
liO.':L-'L ST'�GH 572-9�4�
Po�ver Supplkr Address
Pi�P MPLS G'f FSCE
ElecVical Contractor (Gbmpany Name� Gontrector tJcense No. Master Gc. No_ (Plam Elea. Onry)
NA�TER BLEt:TRI�; �D..INL. CA01192
Mailirg Atltlress (Con�racto� or Ownps Porfoem�ns Inslallation)
:) ' C
Au�honzed SiBnature (GOnhacror or Owner Periorming Insiellation) � Pno�e No_
�r
� EB-OOOOtA-11 8i95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY