P - 81130���2-°168 �
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Home Duplex
Commercial Industri
Air Cond. Htg. Ec
Dryer Range
"X" above the work covered
REGIUEST FOR ELECTRICAL INSPECTION �
Minnesota State Board of Electricity 3
1821 University Ave., Rm. S-128, St. Paui, MN 55104 �
Phone (612) 642-0800 'a��
Apt. Bidg. Other: New Addn
Farm � Remod Re air
Water Htr. load Mgmt. Other:
Elec. Heat Temp. Service
request. Fnter remarks in �his space and on the back of the white copy on1y.
Cakufate lnspectron Fee - This lnspeciion Request wif! not be accepted without fhe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps %,�
Sheet Ltg./TrafFic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY � TOT.A�O
Sign/Outline Ltg. Xfmr. �!� L/�' Lr
Alorm/Remote Control /ik,:�Jp�'�- �-arJ �'�
Swimming Poo) ty �/�• �
I hereb ceAi that I ins ted the elechical installation described herein on the dafes �w
irrigation Boom RougMn � D
Special Inspe -
F�inal
Investigotive ee -- �� ^�C�
THIS INSTAtLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
. � OFFICE USE ONLV This requesf void 1 S months from validafion dafe printed in ihis box.
I IIN II lil N ili II lil II II! II III�iI l�� �i I�I �~-��� �
* 0 8 0 2 1 6 8 5* l�d
PLEASE PRINT OR TYPE
Request Date . Rou h-in ins �on r uired? Yes
g pect' eq ❑ No Inspection Ofher Than RougMn: ❑ Ready Now ill Call
� Z �1 �C� �Ynu must call the inspector when ready) Date Ready:
I, ❑ licensed contractor �-owner hereby request inspection of the above electrical work at:
Job Address (SheeT, Box, or Route No.) Ciy Zip Code
0 0 ��=�jr, ivF' �=�2iD� SSY3z-
Secrion No. Township Name or No. Range No. Fire No. ouny
— o� ri G 7 — DiL�'�
Occupant Phone No.
��2i5 ,��1 5 �iz-S?2-p�9
Power Supplier Address
(Conhoctor or Owner PerForming
��
iture �Cophpcfor n erFon
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/96 TATE BOA
/19�L5 • �l/rr.�l•s�
Conhacfor License No.
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v.
Masier Lic. No. (Plant Elect.
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