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P - 835707,3�--979 C� 1:.�� REQUEST FOR ELECTRICAL INSPECTION Minnesota State Board of Electricity 1821 University Ave., Rm. S-128, St. Paul, MN 55104 Phone(612) 642-0800 New � � ;.... � Addn Commercia lndustrial Farm Remod Re ai Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: Dryer Range Elec. Heat Temp. Service "X" above the work covered by this reqvest. Enfer remorks in this space and on the back of the white copy only. ��'��' " ` ° Calculate Inspection Fee - This Inspection R st will not be accepted without the correci fee: Other fee # Service Entrance Size Fee # Circuits/Feeders Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps Transformer/Generator INSPECTOR'S USE ONLY TOTAL Sign/Outline Ltg. Xfmr. - s� Alarm/Remote Confrol Swimming Pool I hereb certi that I ins ted the elechical installafion deuribed herein on the dares staled Irrigation Boom RougMn Dare Special inspection �! Investigative Fee f�� -�-- ��p- �7 "'E� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. OFFICE USE ONLY This requesf void 18 monfhs 6o alidation dafe printed in ihis box. I���Il��lll������ll�ll�l�ili�����l�lllll ' ��� * 0 7 3 2 9 7 9 0* ��� PLEASE PRINT OR TYPE Request Date Rough-in inspection required? ❑ Yes ❑ No Inspection O�er Than Rough-In: dy Now � Will Cal) � '� �•��� (You musf call the inspector when ready) Date Ready: I, licensed controctor ❑ owner hereby request inspection of the above electrical work at: Job Address (S eef, Box, or Rou No.) City Zip Code /C> �ib Ue. 3 $ecfion No. Township Name or No. Range No. Fire No. Couny � Occupant /'� Phone No. . _ _� rs s // �... % . . . . n t� "') % � '1 a � C� Power EPENDABLE El � a 9 0 0011 Rap+ds, MN �uthorized Signature (Conh, n Address y ;T�tC. INC. ` ing Installafion) 5 4'_ � � � n,�:re. u�. r.�. ��� � �� �� _ � STATE ARD-� OPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY ����