P - 79432('� REQUEST FOR ELECTRICAL INSPECTION �"'��,,
8 U�- 3 6 2� Minnesota State Board of Electricity ����
. 1821 University Ave., Rm. 5-128, SL Paul, MN 55104 �
Phone (612) 642-OBqO„n „ ����t
New
Air (:ontl. Hfg. tquip. Wofer Htr. Load Mgmt Ofhec
Dryer Range Elec. Heof Temp. Service
"X" obove fhe work covered by this requesi Enter remarks in/ t7his sp ce and on the bnock ¢f he white copy
U�a�f'L, i�cc�l� a onz 17cr�
Colculote Inspection Fee - This lnspecfion Reques� will no/ be accepfed wi�hout the correct Fee:
Other Fee N Service Enhance Size Fee # Circuits/Feeders F
Mobile Home Park Sfall 0 l0 200 Amps 0 l0 100 Amps
Slreet Lig./Troffic Sig. Above 200_ Amps Abave 100_ Amps
Trontformer/Genemtor MSPECTOq'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. i,r ;,,1 I, �
Alorm/Remofe Control � t ` �
.___ __.... ..._...._____..._ ... ..........�.....,..�....�....,...�..�,..����„�.,�����.,,.��.�����„
Irrigafion Boom eo�gM� -
Speciaf Inspecfion � ^ ' ��
Imesti otive Fee F���I °� � %-�ZG3
TNIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTNS.
oFFiee use on�r m�, ��.�.p�a mo�ms hom.roudaro� aaie P,�mea �� ih�� ho,.
IIIIIIIIIIII II IIIII IIIIIII�IIIII NII �
* 0 8 0 2 3 6 2 4 s ��y7 r ,Cf/,50
PLEASE PRINT OH TYPE
Reques� Do�e Rougbin Inspec�ion required? es ❑ No Inspecnon Other Than Rougbin: ❑ keody Now WIII Call
O�y— �� h"a mos� coll �he inspec�or when ready� Date Ready:
I, ❑ licensed caniractor L`lowner hereby requesl inspectian of fhe above eleclrim) work at:
lob Address �SVeet, Bw, a Rouk No.) Ciy Zip Code
/373 , �c� F�/DC Ssy32
Sec�ion No. Twvnshio Nome or Na. Ranee No. _ Fire No. Couny _
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73 �Y� �� F�//%(.ct`//'2/li S`S'�3 2
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STATE BOMD COPY - SEE INSTfiUCTIONS ON BACK OF YELLOW COPY