P - 79674.
�U2-307 �
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Commercial
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REGIUEST FOR ELECTRICAL INSPECTION �
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �:
Phone(612)642-OS00 "�"
Duplex Apt. Bldg. Other: j� New Addn
Industrial Farm � � .�C Remod Re air
Htg. Equip. r. Load Mgmt. Other:
$a�e�— Elec. Heat Temp. Service
:overed by this request. Enter remarks in this space and on the back of �he white copy only.
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Calculate Inspecfion Fee - This Inspection Request will not be accepted without the correct fee: '
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
$treet Ltg./Traffic Sig. Above 200 Am s Above 100 Am s
Transformer/Generator INSPECTOR'S usE ON�Y TOTA
Sign/Oudine Ltg. Xfmr. 2 9�� i; ��
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins cted the electrica ' stallation described herein on the dafes stated
_ Irrigation Boom RougMn D /
Special Inspection �( `S-d Z'
Final Dp1e�
Investigative Fee J
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE IJ.RE ONLY This request void 18 monfhs from validation date printed in fhis box.
I II�1 �I I/) �11�1 II III II III II III �� II) II I� ���� �,I
* 0 8 0 2 3 0 7'i * �* ��'s ,� ��
PLEASE PRINT OR TYPE
Requesf Da Rough-in inspecfion required? ❑ Yes ❑ No Inspecfion Other Than RougMn: ❑ Ready Now Q Will Call .
��l (pj - vo2 (You must call the inspeclor when ready� Date Ready:
I, ❑ licensed conhacror � owner hereby request inspection of the above electrical work at:
Job Addreis �Sfreet, �, or Roure No.) Ciry Zip Code
� t 70 � ss�u3.�
Section No. Township Name r No. ��� Ra�e No. Fire No. Couny
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Power Supplier
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Eleclrical Confraclor �Company Nor
Mailing Addreu (Conhaclor or Ovn
Author' Signalure (Con r or
I&00001 A-11 8/96
Phone No.
7!0 3-s8�v -0 3P
Master Lic. No.
Phone No.
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STATE BOARD COPY - SEE INSTRUC'iIONS ON BACK OF YELLOW COPY