P - 83329REQUEST FOR ELECTRICAL INSPECTION
��!� �� q � Q � Minnesota State Board of Electricity
� �'� 0 1821 University Ave., Rm. S-128, St. Paul, MN 55104
�
Phone (612) 642-0800 ` '
Home
Commercia
Air Cond.
Dryer
"X" above the
Calculate Inspection Fee - This Insp�
Other Fee
Mobile Home Park Stall
Street Ltg./Traffic Sig.
Transformer/Generator
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Control
Swimmin Pool
Irri ation B om
Apt. Bldg. Other: New
Farm Remod
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
requesl. Enter remarks in this space and on the back of the white copy only.
will not be accepted without the correcf fee:
e�ntrance Size� Fee # Circuits
� Above 200 �
INSPECTOR'S USE ONLY
that I
Q�.100 Amps
Above 100
the elecfrical installation described herein on the dafes smted
9 � KougMn �� j
Special Inspecti / —`s' �
� Final
Investigative Fee �- �-CJt
THIS INSTALLATION MAY BE ORDERED DISCOMNECTED IF NOT COMPLETED WITHIN 18 MOMTHS.
OFFICE USE ONLY This requesf wid 18 months from validaKon dale printed in this box.
IIIIINIlIIIIIIIIIIIIIIIIII��II���I� +� �.5�
* 0 6 3 2 4 0 8 1* 717�
Fee
i �
PLEASE PRINT OR TYPE
Request DaAe Rough-in inspeclion required2 Yes ❑ No Inspection Ofher Than RougMn: ❑ Ready Now ill Call
�Qi�%.��8 (You must caA the inspector whe readyl Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Skeef, Box, or Roote N J ,/ / Ciy Zip Code
!S'f�S %.��/�I�E �V • � • � t 13,t�' `�
Seclion No. 7ownship Name or No. Range No. Fire No. County _
Occupant
�'i�c.c. � JoA•r/ G�1-��
Power Supplier �� Addres;
�i
Elechical Conkacror (Company Name)
Standard Electric Co., Inc.
Mailing Address (Conhador or Owner Perfwming Insrollation)
2672 Mag�e►y�od Drive, Ma�
Authorized Signature � o tor or Owner PerForminq Ins atio
,
ff .Jo��'f
Phone No.
CA01715
MN 55109-
�yg
IONS ON BACK OF
Lic. No.
484-8044