P - 82939REQUEST FOR ELECTRICAL INSPECTION ����..
5 O 7�� C C Minnesota State Board of Electricity
�. V�� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
� Phone (612) 642-0800 ' '
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re ir
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the wo k covered by this request. Enter remarks in this space and on ihe back of the white copy only.
�12 w Gt.sqSy,%L'
����
CS1 c�aa•�. � -� - Zsr� �
Calculafe Inspection Fee - This Inspection Request will noi be accepted wifhout the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/feeders Fee
Mobile Home Park Stali 0 to 200 Amps 0 to 100 Amps
Street Lig./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAIy,
Sign/Oudine Ltg. Xfmr. v
Alarm/Remote Control
Swimming Pool
I hereb certi Ihat I ins the eleclrical installotion described herein on the dales slafed
Irrigation Boom RcwgMn Dare
Special lns °
Final , Dqp�
Investigative F (�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLET�U WITHIN 18 MONTHS.
OFRCE 1lSE ONLT This roquest void 18 months from volidafion dafe printed in this box.
a ��-�
IIIIIIIIIIIIIIIIIIIIII lflllllllll�llll�ll 3� �g
* � 5 � i 8 6 6 ��c pLEASE PRINT OR TYPE
R�9�S� Rough-in inspecfion required? ❑ Yes o Inspeclion Olher Than RougMn: ❑ Ready N Will Call
�You musf call the inspeetor when ready) Date Ready:
I, icensed conhactor ❑ owner hereby request inspection of the above electrical work ar
b� Add �(Street Bo �� N� � � Ciy � Zi�Code��
� �l .� �r` � b Sv 2.
Section No. Township Name or No. Range No. Fire No. Counly
� no �.o`._�
Occupont Phone No.
r�c ���-��
Power Supplier . Address �
Elechicol Contra for �Com Name) Conhador License No. Master Lic. No. (PIaM� Elect. Onl�
o�,�.. «-�. EL� c � ��9 �
Maili� ddress (Conha�r��` �i�g I�fa on) � � � � . ✓� , / �
�"� � T T l �
Au rized Sign re �Con r or erforming Installafion) Phone No.
2g���: ��.�_,��a'b
E 1 A-11 8/96 TATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY