P - 83294REQUEST FOR ELECTRICAL INSPECTION
5��`���1 � Minnesota State Board of E�ectricity
� j- 1� 1821 University Ave., Rm. S-1 St. Paul, N 104
` Phone (612) 642-0800 ���
ome Duplex Apt, Bldg. Other: New Addn
Commercial IndusMial Farm ��` "�G7 mod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
X" above �he work covered by this request Enter remorks in this space and on Fhe back of the white copy only.
Co�culaie Mspeciiort Fee - This Mspection Reqsesi will not be
Otlier Fee # Service Entrance'
Mobile Home Park Stall 0 to 00 Amp
Sheet Ltg./Traffic Sig. Above 200 �
Transformer/Generator INSPECTOR'S USE ONLY
Sign/Oudine Ltg. Xfmr.
Alorm/Remote Control
Swimming POOI I hereb certi ihaf I ins
Irriqation Boom � o��.��
witlrout the correct fee:
Fee # Circuits/Feed�
Orol
Above 100
Fee
2 y_
ihe electrical insfallallon described herein on the da�es stated
Imestigati� V ..._. {�SL L'�-R�"�--- �� - � `
THIS INSTALLATION MAY BE ORDERED dSCONNECTED IF NOT COMPLETED WITHIM 18 MONTHS.
OFFlCE 1/8E ONL�' This requssl void 18 monlhs from validation dafe printed in this box.
lI��I������I�I��������II� III�III����II��� �
� Co`7 I 3 !1(0� S�
* � 5 3 2 5 3 ar ]i * PLEASE PRINT OR TYPE
Request DaM Rou h-in ins on r uved? ❑ Yes
� g pecli eq ' ❑ No Inspection Olher Than RougMn: ❑ Ready Now � Will Call
!O (You musf call the inspeclor when ready) Da6e Reody:
I, ❑ licensed contractor�owner hereby request inspection of the above elechical work at:
Job Address (Sheet. Box, or RouAa No.� Ciry Zip Code
s� �{ � sr- Nc= 1��toc.� ss�sa
Section No. Township Name a Range No. Fire No. Coun
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����� NK S��/t�IP� � � � - 6 g�!
r�. s���. ndd�a�
SP S � ssr N�'
Eleclricel Contractor (Comparry Name) Contrac�or Lice�se No. Mosler lic_ No, �plent Elect. OnM
ng Aaaress (C,onlractw w Uwner Yertorming tnstollation�
.S 9.� � � ..s ! �11t E � , G/i .//
i �) ^ � / Phone No. � �
6 / �
STATE BO COPY - SEE INSTRUCTONS ON BACK OF YELLOW COPY