P - 84625,. _
I I III I) II) �I II III II III II III II ��� ( I��I � 82��ES sFOAve. RmC S-�1I BASt! PauP M`N 505104 ����
Minnesota State Board of Electricity
`' * 0 2 9 9 3 7 8.. 0* Phone (612) 642-0800 � � �
ome Duplex Apt. Bidg. Other: �l Addn
Commercial Industrial Farm emod Re air
Air Cond. tg. Equip. Water Htr. Load Mgmt. Other:
D er Ran e Elec. Heat Tem .$ervice
"X" above the work covered by this request. Enter remarks in this space and on the back of the whitP copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee � Service Emrarxe Size Fee # Cirwits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps �
Street Ltg./Traffic $ig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPEC� E""" Y�,/ '/ TOTAL�� J�
Sign/Outline Ltg. Xfmr. IN ��� �
Ala?m/Remote Control �� � .r. �, C �
$wimming Pool A� / ��� r —
I hereb certi ihat I ins ected fhe eledrical insfol�otion destribed n 6hll�e d4ta3 stale3rl's `[
Irrigdtion Boom ' Rough-In �1 � ^
Special Inspe
Investigative �0� � l/Lc.�i
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 ONTHS. '
2 9 9� 3 7 8 � OFFlCE USE ONLY This request void 18 months from volidation date printed in this box.
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,�/.3 v
r-t�h��.�.�, � �3v3�
PLEASE PRINT OR TYPE
Requestbate Rough-in inspeclion required2 es � No Inspeclion Olher Than Rough-In: � Ready Now i Call
(You must call the inspedor when reody) pafe Ready:
I, ❑ licensed contractor [�owner hereby request inspection of the above electrical work at:
Job Address (Sireet, Box, or Route No.) Ciy Zip Code
<�ri , i ..i/ � — - � — F' — � — — "" —
$eclion No. Township Name or No.
Occupont
Power Supplier
Eleclrical Confin r (Company Name)
Mailing Addrcss (Confractor or Owner Pe�fortning
Aulhorized $ign (C m or or O
EB-000 A-10 6/95 STATE
Range No. Firo No. / Counly
�
Phone No.
57Z-
Address
NLlot B/(�
License No. Moster Lic. No. (Planf Elecf. Only)
In Ilafion) ') Phone No.
� �� ..� 72-
COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY