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P - 80358C�=92�-?58 � � REQUEST FOR ELECTRICAL INSPECTION � Minnesota State Board of Electricity � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 ���� (651) 642-0800 www.electricity.state.mn.us " ' "X" above the work covered by ihis request. Enter remarks in this space and . �/� � ��, copy only. Calculate Inspection Fee - This Inspecfion Req t will not be accepted wifhout the correct fee: Other Insfallafions Fee # Service Entrance Size Fee # Circuits / Feeders Fce Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps Transformer/Generator INSPECTOR'S USE ONLY Sign / Outline Ltg. Xfmr. Alarm/Remote Control Swimming Pool I hereb certi that I ins ecfed the electrical installatic Irrigation Bo ►�� Rough-In stated: Investigative Fee Fir�ol �� I Du� ��,� ��C I ���- THIS INSTALLATION MAY BE ORDERED DISC CTED IF NOT COMPLETED WITHI 18 MONTHS. _ OFFICE USE ONLY This request void 18 monlhs 6om validation date printed in this box. ll���Vl���l������8����1��� • �.� �� * 0 9 2 2 2 5 8 ��c ��aJr PLEASE PRINT OR TYPE 1, icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: Jo Add ss (Street, Box, or Route No.) City__,�� ` Zip Code D � �- �.� $ecfion No. Township Nam���Fi�; No. Ran e No. Fire No. County � � Occupanf L Power Supplier � ^ rl , E��`��`IV`���BL����LEC?RIC. INC. M����oDn e�tapids ��M �5433 �f Aufhorized Signature (Contrac mpany or Owne EB-00001A-12 5/1999 STATE B 7 Phone No. -s-��- ��T�r� IS " �J / V�J� SEE INSTRUCTIONS ON BACK OF YELLOW COPY