P - 81018• . � � �
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Commercial � � Industrial
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REGIUEST FOR ELECTRICAL INSPECTION ���
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800 "�
Apt. Bldg. Other: ew Addn
Farm Remod Re ai
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remprks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without ihe correcf fee:
Other Fee # Service Entrance Size Fee # Circuits/Feedc
Mobile Home Park Stall to 00 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100
Transformer/Generator INSPECTOR's usE oN�v TC
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Fee
0
Swimming Pool (1� �
I hereb certi that I i ed the electrical installafion described herein on the dates sta�
Irrigation Boom . Ro� h-I� Dare
,. .,, . ._. 9 �- �i` la/�9:
� Investigative Fee '` � I`�' �-� ,!�../S �, ���e � V� y�–'1"�j� �
THIS INSTA�LATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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OFFICE USE ONLY This requesf void 18 monfhs from validation dafe printed in fhis box.
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PLEASE PRINT OR TYPE
Requesf Da�/ � �� Rou h-in ins ion re uired? es
�.� g pecY q ❑ No Inspection Ofher Than RougMn: ❑ Ready Now ill Call
Cv �You must call the inspector whan ready) Date Ready:
I, censed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Add`re�ss �(Sh `' Box, or Route No.) ^� ` Cii�� Zip Code
'7 J rl C� 3 7`f � f—r� �`G� �r .
Section No. Township Name or � Range No. fire No. Coun
Occupant
Cp .� .rt C /` C !�'� �
Power Supplie��
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�� Phone No.
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Address (Conhacfor or Z e� e3 ���ro� af;� ��7 L��C' �,, �/ .�53 o S
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er PerFor . I tio Z Phone No.
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY