P - 82472"' � �r RE(�UEST FOR ELECTRICAL INSPECTION ; :a��� ..
Q("� ") ��� Q � Minnesota State Board of Electricity ':
V li L J 1821 University Ave., Rm. S-128, St. Paul, MN 55104
_ Phone (612) 642-0800 "�°`
Home Duplex Apt. Bldg. Other:
Commercial Industrial Farm
Air Cond. Htg. Equip. Water Htr. Lood Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on
New
Remod
copy
Calculate Inspection Fee - This Inspection Request will not be accepted without die correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
$heet Ltg./Traffic Sig. Above 200 Am s Above 100 A�
Transformer/Generator INSPECTOR'S USE ONLV ���,�� TOT,
$ign/Outline Ltg. Xfmr. �i � �� ���
Alarm/Remote Confrol
Swimmin Pool
F�
'sa
9 I hereb certi tFwt I ins the elecfrica 'nsfallotion described herein on the dates sta�ed
Irrigati m RouyM�
Specia � 'Z" Z 7—�d
Final
Investigative Fee - — � �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monihs from valid ' afe printed in fhi�box.
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* 0 8 0 2 2 2 9 5* l� ,�
PLEASE PRINT OR TYPE
Requesf Dafe Rou ffin ins on r uired$ Yes
g pecli eq ❑ No Inspection O�er Than RougMn: ❑ Ready Now Will Call
' ��— �q � Qp� �`!ou must call the inspector when ready) Date Ready:
I, ❑ licensed contractor � owner hereby request inspection of the above elechical work at:
lob Addreu �Sheet, Box, or Route No.) Ciy Zip Code
�630 �t�. ST. N�= F'2�o,.�'� Ss�l3Z
Section No. Townshio Name or No. Ranqe No Fire No County
�`�t�t+r� R,� ..� j! L.R-�
Power Supplier � S P �
Elechical Conhaclor (Company • � �-.
OW 1S E,� v C5
Moiling Address (Conhacfor or Owner Performing Insfallation�.
S 4 t�E
. . A N o K.Pt
�,� No.
7�3 -5 71 ~�70 �{
p/�P�.S_ I�b�t DtJtSto
�„w,, I 76��-s7 t 570�{
BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY