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P - 83239REC�UEST FOR ELECTRICAL INSPECTIOI �C � G� f1 �� � Minnesota State Board of Electricity U^ J V i 821 University Ave., Rm. S-128, St. Paul, MN 551 � 1 Phone (612) 642-0800 Home Duplex Apt. Bldg. Other: Commercial Industrial Farm Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: Dryer Range Elec. Fieat Temp. Service "X" abov �the work covered by fhis request. er remorks in this space and on the back of the whitE `��c� 1�� u�� � �� Calculate Inspectio ee - This Inspection Request will not be accepted without the correct fee: Other Fee # Service Entrance Size Fee # Circuits/Feedei Mobile Home Pork Stall 0 t 00 Amps 0 to 100 Amps Street Ltg./Traffic Sig. Above 200 Am s Above 100 / Transformer�Generator INSPECTOR'S USE ONLY TO� Sign/Outline Ltg. Xfmr. � Alarm/Remote Conhol � Swimming Pool I here cerfi that I ins the electrical insMllation described herein on the d� Irriqation Boom e��,i..�., n..,� New copy � Fee � Special Inspect' C' �7 ' '" / l`7 0 Final te Investigative F 2 ' -� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. OFFICE USE ONLY This request wid 1 S monlfis from validaiion date printed in this box. �lil��l�il��l�l��ll����lllf���������������1�� • * 0 6 7 5 0 3 4 3� No. PLEASE PRINT OR TYPE Rough-in inspection required$ es ❑ No Inspection Other Than Rough-In: ❑ Ready Now (`/ou musf call fhe inspector when ready) Date Ready: contractor ❑ owner hereby request inspection of the above elecfrical work at: Bo , o.) �� City � Zip C I �� � iship Name w No. Range No. Fire No. Couny 1 � No. Call �mmg msmnanon� . [1 ("a ��' r; I Y�J� �— 33�5 IV J J V BOARD COPY - SEE INSTRUCTIONS �N BACK OF YELLOW COPY