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P - 79628, ,� �0��311 � REGIUEST FOR ELECTRICAL INSPECTION Minnesota State Board of Electricity 1821 University Ave., Rm. S-128, St. Paul, MN 55104 Phone(612)642-0800 Home Duplex Apt. Bldg. Other: New Commercial Industrial Farm �tL��� • `X..Q•l�?v�T—°°`� Remod Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: Dryer Range Elec. Heat Temp. Service "X" above the work covered by this request. Enter remarks in this space and on the back of the whiie copy � �.ke� .. r -�1� � _..� Calculote Inspection Fee - This Inspection Request will not be accepted without the correct fee: Other f Service Entrance Size Fee # Circuits/Feeders F Mobile Home Park Stall � 0 Amps 0 to 100 Amps Qjj Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps Transformer/Generator INSPECTOR'S USE ONLY TOTAL, / Sign/Outline Ltg. Xfmr. �/ � � Alarm/Remote Conhol $wimming Pool I hereb certi that I ins cted the elechical installation described herein on ihe dates stated _ Irrigation Boom Ro„9h-yya ' 3�U,� Special Inspection Z Final Da _ � Investigative Fee THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. OFFlCE USE ONLY This requesf void 18 monfhs kom validafion dafe prinfed in this box. IIIIIfIIIIIIIIIIIIIIIIIGIIIIIHNIIIIII�IIIII�I �,�,l * 0 8 0 2 3 1 1 1* ��/"� '� ,(����� PLEASE PRINT OR TYPE Requesf pote Rou h-in ins ecfion re uired8 Yes g p q ❑ No Inspecfion Ofher Than Rough-In: ❑ Ready Now Will Call p� (You must call the inspector when ready) Date Ready: I, ❑ licensed confractor �owner hereby request inspection of the above electricol work at: Job Address �Sheef, Box, or Ro�fe No. J Cily Zip Code �'�d `� �. ��` �����L�-� �5��� Section No. Township ame o�D RaFg� . Fire. No. County ^ � � O� Occupant ��1 t- Phone No. �) � � XAcll3��� "l /n7 -S�/ - Z�9 X il Conhacior'C�6mp�ny Name�� I Conkacfor License No. I Masfer Lic. i i� w Address IConka�ctor orJa,wner Pvdecmino Installafiuul � � �� "3 BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY