P - 82737,. REGIUEST FOR ELECTRICAL INSPECTION
5�J ..�`� � 6 5 5 Minnesota State Board of Electricity
t 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Indushial Farm Remod 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 the back of tf�e white copy only.
���0 �,�,C1��-S��
Calculate Inspecfion Fee - This Inspection Request will nof be acce
Other Fee # Service Entrance Size
Mobile Home Park Stall 0 ro 200 Amps
Sheet Ltg./Traffic Sig. Above 200 Am �
Transformer/Generator INSPfiCTOR'S USE ONLY
Sign/Oudine Ltg. Xfmr. �
Alarm/Remote Control
Swimming Pool
1 her certi that I ins the �
Irriaption Boom _ � o�.,�i.,..
-1i�--1���
without the correct fee:
Fee # Circuits/Feeders
0 ro 100 Amps
Above 100 Ai
fee
Investigative F�e f -'��._._�.
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFRCE USE W�1LY This request void 18 months from validation dafe prinfed in fhis box.
I IifI+f1IfIfI • lJr 5Z
�IIIII�IIlIIlllll�ll�l Illl��ll�llt I I ---
11 I Ilil
* 0 5 9 8 6 5 5 9�: 7� �
PLEASE PRINT OR TYPE
Request Date
2� ��(� Rough-in inspection required$ ❑ Yes No Inspeclion Other Than RougMn: ❑ Ready Now �II Call
b (You must call the inspeclor when reody) Dafe Ready:
I, lLhlicensed confiactor ❑ owner hereby request inspection of the above electrical work ah
Job Address (Sheet, Box, w Roufe No.) Ci P
IS�i1 -i3� 2�A�v�e i� . ry�Y'IC��-c.� ZS�`��Z
Section No. Township Name or No. Range No. Fire No. Cou tv
y �� �t'uYl
Power $upplier
Electrical Conhacror (Compn (�
BLAINE HT�.
��/�.�..J�
ELECT., INC.
Phone No.
�'1 B 3-2�`��
�� _I � I MaSter ��. No:
er Performiqp InaMllation) .. � P�� �.
�� 9� =i �t S�1-�2ao
STATE BpAR� C�PY - SEE �INS7RIICTIONS ON 9ACK OF YELLOW COPY �