P - 83885REQUEST FOR ELECTRICAL INSPECTION =-�.
5�� �� O ° Minnesota State Board of Electricity �I
1821 University Ave., Rm. S-128, Si. Paul, MN 55104
Phone (612) 642-0800
me Duplex Apt. Bldg. Other: New Addn
Commerciai Industrial Farm Remod Re ir
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
D�yer Range Elec. Heat Temp. Service
"X" above ihe work covered by this request. Enter remarks in this space and on the back of ►he white copy only.
��,� �-..�-�—� �-�J
Calculate Inspection Fee - This Inspection Request will not be accepted without ►he correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi thai l ins ected fhe elecfrical installation described herein on the dafes sfated
Irri9ation Boom RougMn � Da�y/ `
Special Inspecti l -
Final Date
Investigative Fee -1�- �
THIS INSTALLATION MAY BE ORDERED DISCO CTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monfhs from validation date printed in this box.
i �����
� ���� (� �I� �� ��� (� ��I ���� �� ��) �� ��� �� ��� ( ���� ��� �
* 0 5 4 2 3 3 0 6 * ����
PLEASE PRINT OR TYPE
Request ate Rough-in inspection required? ❑ Yes �lo Inspection O}her Than RougMn: ❑ Ready Now Will Call
� �� �� (You musf call fhe inspector when ready) Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Roufe No.) City Zip Code
...r. _ '�e.�.� �. �_l �r. � . n S-'\ �—�i—�� r.' � . � ✓.✓ _ . �..�
Power Supplier
1
or No. Range�Plo. I Fire No. I C�('il�y ����� �
� � v'� .
�...-�i r
Name)
�
(Conhactor or Perfo ing Installation)' � Phone No.
f'��! � �.�� 25J�:{ c��)—
,
S�TATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
Elect. Only�