P - 81457/ � REQUEST FOR ELECTRICAL INSPECTION
/�� L— 5 5 4 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Indusfrial Farm Remod
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by fhis requesf. Enier remarks in this space and on the back of ihe whiie copy
�����
Calculafe Inspection Fee - This Inspection Request will noi be accepted without ihe correct fee:
Other Fee # Service Entrance Size Fee # Circuits
Mobile Home Park Stall 0 to 200 Amps 0 to 100 A
$treet Ltg./Traffic Sig. Above 200 Am s Above 100
Transformer/Generator INSPECTOR'S USE ONLY
Sign/Uudine Lfg. Xfmr. �zY� � ��� j`ss £'�
Alarm/Remote Conhol '� �"'
- ;n;,.
, �1.
�./ ��A
Fee
/�O I
/
Swimming Pool ou -N-l-t`-aI
I hereb certi that 1 in the ' srollafion described herein on the dates slaled
Irrigation Boom R M„ •
Special Inspection � � 'Z y _f
Final p� ! _
Investigative Fee _t„op ��c
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 ONTI
OFFN:E USE ONLY This requesf void 18 monlhs From validaKon dale printed in this box.
1 �
���NN�������� IIIIII����������������N�������� �/��o.� � ` � _f ,e*_ �a
� 0 5 3 2 5 5 4 3� �
�L T OR TYPE
Requesf Dafe Rough-in inspecfion required? ❑ Yes
❑ No InspeRon Than RagMn: ❑ Ready Now � Will Call
(You must call the inspecfor when ready� Dafe Ready: �
I, ❑ licensed confractor ❑ owner hereby request inspection of the above electrical work at:
Job Addreu (Sheet, Box, or Route No Ciy Zip Code
C� o u 5�-"` ��- Yl� ��, 3�.
Secfion No. Township Name or No. Range No. Fire No. Couny ,
Ottupanf � � �
{ �
Power Supplier ��
i
Electricol Contractor (Compan Name)
Mailing Address (Coohactor or er
`eQa� �r
Aulhorized Signatur �Conhaclw or �
�OOOOIA-11 8 ST�
a � Phone No.
� c..)
lic�ense No.
• �iv --� �
—__�c
BOARD COPY - SEE INSTRUCTIONS ON BACK oF vE�ow rnav
u�. r�.