P - 80659Z�'7-532 �
s
Home Duplex
Commercial Industri
ir Cond. Htg. E<
Dryer Range
"X" above the work covered
REQUEST FOR ELECTRICAL INSPECTION °'E
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �;
Phone (612) 642-0800 `'�'
Apt. Bldg. Other: ,��.�' 1 `n //J p New Addn
�I Farm i�/rl' 1(,(,l�'C.� Remod Re air
uip. Water Htr. toad Mgmt. Other. � p�
Elec. Heat Temp. Service � � �ll�(,�� �
by �his request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without fhe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
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 u5E oN�v TOTA d"%
Sign/Outline Ltg. Xfmr. 9`+'
Alarm/Remote Confrol
Swimming Pool
I hereb certi that 1 ins ed the elechical installation described herein on the dates sroted
Irrigation Boom Rougftln Date
Speciallns t
FiAOF'" _ D4 .� Z�'�—'OC>
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� OFFlCE USE ONLY This request void 18 months from validafion dafe prinfed in this box.
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PLEASE PRINT OR TY�PE
Requesl te Rou h-in ins hon r uired2 Yes
�° ��� g pec' eq ❑ No Inspecfion Other Than Rough-In: Ready Now ❑ Will Call .
`�j (You must call fhe inspector whe ready) Date Ready:
I, ❑ licensed co tractor ❑ owner hereby request inspection of the above electrical work at:
Job Addreu (Stree Bo� Route No.) , �/ ;_^ Ci1y Zip C� � �A2
�V � / l {� t J�
SecTion No. Township Name or . � Range No. Fire No. County � l�
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Occupant �/j%� `�� , %� SU f � (JQ{� �� 7��^, i)I. Phone No.�� � ��iCl �C/ L
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Power Su er /�i ^
pP � � /'� � � ��/ ddress ( /VI I �j� W � I .-C.r
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Eleckica�hac�or� ny Nam � p ` Conhactor L�se�lo� � Mas r Lic. No. (Plant Elecl. O� �.. \
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Mailing A ess �Conhacror Owner Pe rming Installafi � �
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Aufhorized $' re �Contractor r Owner rForming Insfall ion) �� Phone��� �
EB-00 1A-11 8/96 STA ARD COPY - SEE INSTRUCTIONS ON BACK OF YE