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P - 81488,, REGIUEST FOR ELECTRICAL INSPECTION � :� 51- 510 Minnesota State Board of Electricity 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �. Phone (612) 642-0800 Home Dupiex Apt. Bldg. Other: New C mmercial I dushial Farm Remod �ir Co 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 white copy only. -�� �?��- .�� � �� Calculate Inspection Fee - This Inspection Request will not be accepted withoui the correct fee: Other Fee # Service Entrance Size Fee # Circuits/Feeders Mobile Home Park Stall 0 to 200 Amps to 100 Amps < Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps Transformer/Generator INSPECTOR'S USE ONLY TOT � Sign/Outline Ltg. Xfmr. , < Alarm/Remote Conhol Swimming Pool I hereb certi that I ins ted the elechical installation dexribed herein on the dates stated Irrigation Boom , RougMn pa� Special Inspecti Investigative Fee F� �°� �� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MO fee OFFICE USE ONLY This request void 18 months 6om validallon date printed in this box. I�IIIIIIIIIIIIIIIIIII �� �� �5 � ���III��I� * 0 7 5 1 5 1 0 9* �'0 7 7 PLEASE PRINT OR TYPE �uesf Dafe Rough-in inspection required? � � ❑ Yes No Inspection Olher Than RougMn: Now ❑ Will Call �� � (You musf call fhe inspecfor when ready� Dafe Ready: licensed contractor ❑ owner hereby request inspection oF the above electrical work ot: ddress (Sfr f, Box, or Route t�a.) ���- C�h, �� Zip Code % ���/ lion No. Township ame or No. Ranqe No. Fire N� �,.,,.,., co�h«ro. Addreu (ConhqcYOr or Phone No. ��y �G Conhactor License No. MasTer Lic. No. (Plunt Elect. � n � _ c � J — - I � -li�� STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY