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P - 82914REGIUEST FOR ELECTRICAL INSPECTION 6/�• Jlr� p p� � Minnesota S1ate Board of Electricity �� �+ o 0 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 air Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: Dryer Ran e Elec. Heat Temp. Service "X" a ove the work covered by this request. Enler remorks in this space and on the back of the white copy only. / � � Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee: Other Fee # Service Entrance Size Fee # Circuits/Feeders F 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 v Alarm/Remote Control Swimming Pool `_ I hereb certi that I ins fed the eleckical insfallation described herein on the dates sfated Irrigotion Boom Rouglfln Dare Speciallnsp 'o i Final � �f1Y@St19UtIV@ THIS IN5TALLATION MA BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. OFFICE USE ONLY This request void 18 months from validafion date prinfed in this box. �� �� ��{ �I ��� H ��� �� Iii�IMll� �� �I� I� N{ {I I� �� '� ��n * 0 6 4 4 8 8 5 6* �� PLEASE PRINT OR TYPE Requesf Dafe� .�� Rough-in inspection required$ ❑ Yes ❑ No Inspecfion Other Than RougFrin: Ready Now 0 Will Call . (You musf call Ihe inspector when ready) Date Ready: I, licensed contractor ❑ owner hereby request inspection of the above electrical work at: J Addreu (Sheef, Box, or Roufe No.) City Zip Code � Secfion N. Township ame or No. Range No. Fire No. Coun � Occupan Phone No. V �L ��� Power upplier � Address Electrical ConhaMOr (Company Name) Co a Licens�� Mosfer Li . No. �Plant Elecf. Only� EPENDABL� £L� T ---�3 j� ( tr ��Per��g InsMllation) on Rapid�, MIV 5 3 . Authorized $ig�wture actor or Owner Perfor in Instoll ��_s ~-:� Phone No. � �� O EB-0OOOI A-11 8/9 STA BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY