Loading...
P - 8180977-�-�03 � RE(�UEST FOR ELECTRICAL INSPECTION Minnesota State Board of Electricity 1821 University Ave., Rm. S-128, St. Paul, MN 55104 Phone(9� 642-0800 Home Duplex Apt. Bldg. Other: Commercial Industrial Farm Air Cond. Htg. Equip. Water Htr. 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 ihe whif iY� � �i' � � !� cT/'-� �a C S � /'�- C � A�a( oc a� T�� T' � S�a��. ��� c%r Calcubte Inspection Fee - This Inspection Request will not 6e accepted witfiouf the correct fee: Other fee #. Service Entrance ize Fee # Circujts/FeedE Mobile Home Park Stall 0 to 00 Am s a 0 to 100 Amps Street Ltg./TrafFic Sig. Above 200 Am s Above 100 Transformer/Generator INSPECTOR'S USE ONLY tC i Sign/Outline Ltg. Xfmr. �„�.,��`.� {`� G� � Alarm/Remote Control Swimming Pool .._ ._ _ I herebv terti(v thaf I insoecfed the elechical insfallafion descri6ed herein on the c New Remod Date copy � � '� 1 — � •� Fee rmal U � �� lnvestigative Fee � THIS INSTALLATION MAY BE ORDERED DISC NECTED IF NOT COMPLETED WITHIN 18 MONTHS. - OFFlCE USE ONLY This requesf void 18 monihs {rom validafion dafe printed in fhis box. . I �II �I I�I (I (II (I (�� I� III �� �� � (I� ��'�� � � ` �v �' * 0 7 7 4 5 A 3��c �� PLEASE PRINT OR TYPE � � Requesf D Rou h-in ins tion r uired? ���� g pec eq ❑ Yes No Inspecfion Other Than Rough-In: ❑ Ready Now ill Call (You must call the inspector when ready� Date Ready: I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at: Job Address (Sheef, Box, or Route No.� Zip Code yZ> �l � �2 id /�° Section No. Township Name or No. Range No. ounly Power UI /18U�t r U� H l� Mailing Address �Conhacfor or Ow A orized Signat�re (�n�for or OOOIA-11 6 Phone No. Q �; � .- 7 �s�y- �, ��: S Conhacfor License No. Masfer Lic. No. � 0 _.. _.___ � ..._.._. . �- � ' yy- STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY