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P - 80712REQUEST FOR ELECTRICAL INSPECTION 5� 2- 5 7 S Minnesota State Board of Electricity iS21 University Ave., Rm. S-128, St. Paul, MN 55104 ` Phone (612) 642- 0 Home Duplex Apt. Bldg. Other: -� New Addn Commercial Industrial Farm S'� Remod Re air Air Cond. Htg. Equip. Water Hh. Load Mgmt. Other: Dryer Range Elec. Heat Temp. Service "X" above the work covered by ►his requesi. Enter remarks in this space and on ihe back of the white copy only. Calculaie Inspection Fee - This Inspection Request will not be accepted without the correct fee: Other Fee # Service Entrance Size Fee #; Circuits/Feeders Fee Mobile Home Park Stall 0 to 200 Amps 0 ro 100 Amps � Dd Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps Transformer/Generator INSPECTOR'S USE ON�v�� �p0 TOTA�/` `� Sign/Oufline Ltg. Xfmr. �✓Gcx.it ���"X ��'�%' , y^ � `� Alarm/Remote Conhol Swimming Pool 1 here " ihaf l in the el ' I inslallafion descri m on Irrigation Boo RougMn Special lnspection ! �� "�^ �`-� '—' Rn�— Dote Investigative Fee � � ^ THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. OFRCE USE ONLY This requast void 18 months kom validation daSe printed in this box. iiii�i{�i�iiiiiii�{ii�ii�� iiiiii���� � ���� * � 5 3 2 5? 8 2* � `�� 7� PLEASE PRINT OR TYPE R Rou h in ins on r mred$ Yes p�G� g pecfi eq ' ❑ No Inspeclion 01her Than RougMn: ❑ Ready Now �II Call •(/ �You must call 1he inspacror read� pate Ready: I, ❑ licensed contractor �'owner hereby request inspecFion of the above electrical work at: Job Addreu (Sheef, Box, a Route No.� City Zip Cocle lQ�'D �% �'f' �L � �Q� � �S Z Section No. Township Name or No. Range No. Fire No. County '�o �� �ho�a Occupanf ��,C r�`, ./ P e No. F� �• '� ��a s�a-3�sz �,� r.n Power Supplier � ^ � � q��y � � �� � , � � r � 6 Yf� Elechical Conhacror (Company Name� Contraclor licenae No. Master lic. No. �PIaM Elecf. Only� �W � e�-- . Mailing Addmss (ConhacHor or Ow�r Performing Msfallation) � � �e r-►-�.� AWhwi ignature (Conhacfor or er P ing Installalia�) �-� ',� Phone No. ��� ' ` -.� 5�a-3�s E 1-11 8/96 �ATE BOARD COpY _ SEE INSTRUCTIONS ON BACK OF YELLOW COPY