P - 80486REQUEST FOR ELECTRICAL INSPECTION �
6 n r' ���� Minnesota State Board of Electricity
Y U �� 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �:
. Phone (612) 642-0800 " '
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: `
Dryer Range Elec. Heat Temp. Service �'1 �- �1uV'W� � lj
"X" above the work covered by this request: Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted wiihout the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Tronsformer/Generator INSPECTOR�S USE ONLY TOTryAL t
Sign/Oudine Ltg. Xfmr. s7� 7�
Alarm/Remote Control S.W 7rw�d»t.4+f�O.�i�
Swimming Pool '!`�+� 5�'+'fG
I here certi that I ins the eleclrical installafion deuribed herein on the dates stafed
Irrigation BQOm (� RougM� Dare
Special Inspection
Final � .,Z�
Investigative Fee —/�% �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WRHIN 18 MONTHS�
OFFICE USE ONLY This request void 18 months 6an validafion date printed in this box.
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* 0 6 0 0 1 2 2 6� ��' ��; ��j��
PLEASE PRINT OR TYPE
Requesf Dote Ro h-in ins on uired?
��T �� ug pecfi req ❑ Yes �No Inspeclion Ofher Than Rough-In: ❑ Ready Now �Will Call
�`/ou must call the inspeclor when ready) Date Ready:
I, � licensed contractor ❑ owner he�r�b request inspection of the above electrical work at:
Job Addrea (Sheet, Box, a Rou1e No.) Ciy Zip Code
�S'�3o � 5�. � Fr; c� ��c SSy� l
$ection No. Township Name or No. � Ranae No. Fire No. ounN
No.
�r zl S��l -
Contracbr (Company Name) Contracror License No. Mas�ar lic. No. (Plant Eleci. Only
� Vol � �ok ac��r-s ���C�
�ddress (Con aclor or Owner PerForming Insfallation)
� � � �di�kw WtN � s� 3S
d Signatura (Con w PerSorming InsTaNaKon) Phone No.
� 9'S� 35-4�G�o
A-1 1 8/9 �p� gppRD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY