P - 82807REQUEST FOR ELECTRICAL INSPECTION
6�` ����� � Minnesota State Board of Electricity
v 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
Phone (612) 642-0800 ���
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Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Con Htg. Equip. Water Htr. Lood Mgmt. Other:
Dryer Ran e Elec. Heat Temp. Service
"X" above the work covered by this request. Enier remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - lhis lnspection Requesi wi!! noi be accepted wiihout ihe correct fee:
Other Fee # Service Entrance Size fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 ro 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 mps
Transformer/Generator INSPECTOR'S USE ONLY T �
Sign/Oudine ltg. Xfmr.
Alarm/Remote Control
Swimming Poo)
I here certi thal I ins the elechicol insfallafion described herein on the dafes sfa�ed
Irrigation Boom RagMn Dore
Special Inspecti
fino) D L,"
Investigative Fee ' —Z
7HIS INSTALLATION MAY BE ORDERED DISCON D IF NOT COMPLETED WI IN 18 MONTHS.
OFFICE USE ONLY This request wid 1 A monfhs 6om validation date printed in ihis box.
III�OIIII���l��lillllii�llllill�l������il�� � ��`�
* 0 6 6 2 8 9 3 �� ����
LEASE PRINT OR TYPE
RouBh-in inspecfion required$ ❑ Yes o Inspecfion Ofher ihan Rough-I Ready Now � Will C.all
�You must call the inspector when ready) Date Ready:
confractor ❑ owner hereby request inspection of the above electrical work at:
�x, or Rwte J I 1 /1 Ciw _ /I . . /1. . _ 7�n.C'�d. � _
No.
Occupanf
Power Supplier �/ - � " � Address
�I Conhactor �Company Name� `y• ��yQ n ctor Licen o. Masfer lic. No.
y;t,^.--'���Nn 8L ..5'flN.S` �'.T.E
gTG. & AI�',
ddres�.�@UN�a�� )
CRY5TAL, MN 6542 6 3
ced Signature �Con or er orming sta 'fion) Phone No.
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1A-11 8/96 STATE B RD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY