P - 80102. REGIUEST FOR ELECTRICAL INSPECTION ;-�°"
8(Z ���� Q � Minnesota State Board of Electricity
��' `•� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
' �r
Phone(612)642-0 00 " '
Home Duplex Apt. Bldg. Other• � New Addn
Commercial Industrial Farm �� � emod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on ihe back of the white copy only.
Calculafe Inspection 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 (? to 200 Amps 0 to 100 Amps
S Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
sformer/Generator INSPECTOR'S USE ONLV �� _/ TOT /
Sign/Outline Ltg. Xfmr. �j� ���� '�'
Alarm/Remote Control g g g�3 �
Swimming Pool
I hereb cerli the electr'cal installation described herein on the dates stated
_ Irrigation Boom Rough-In / Dare
Special Inspection �i CO • 2 - G'�
Investigative Fee �� �� //C-2� ��j' � � �' O3
THIS INSTALLATION MAY BE ORDERED DISCONNECTED I NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void �months from validation date printed in this box.
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIiII�N�II�I '�
* 0 8 0 2 3 5 9 0* ����/�
PLEASE PRINT OR TYPE �"S�
Raquest Date Rough-in inspecfion required? ❑ Yes
❑ No Inspeclion O�er Than RougMn: ❑ Ready Now Q Will Call
� �You must call the inspector when ready) Date Ready:
I, ❑ licensed co�tractor � owner hereby requesh inspection of the above elechical work at:
Job Address (Street, Box, or Route No.) City Zip Code
i�t� `73i f�ve NE �Q��pLF`� 55�3Z
Section No. Township Na Range No. Fire No. Couny
• uWV `
Occu nt Phone No.
+ b�a Jac�l�els `��.3--��0 ^8�1�3
Power Supplier Address
Name)
4ddress �Conhacto� or Owner Performing Insfallafion)
:d Signafure �Conhacfor or Owner Performing Insfallafion) phone No.
A-1 1 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY