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.
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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