P - 78476��_
REQUEST FOR ELECTRICAL INSPECTION - �...
� ,4 � � g � �8 � Minnesota State Board of Electricity -
� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Home plex Apt. Bldg. Other: New Addn
ommercia lndustrial Farm Remod Re ir
Air Cond. Htg. Equip. Wafer Htr. Load Mgmt. Okher:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this reqvest. Enter remarks in ihis space and on the back of ihe white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepied wiihout the correct fee:
Other Fee # Service Entrance Size Fee # Circuits{Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to i00 Amps �d �Z�
Sheet ltg./TrafFic Sig. Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTA
$ign/Oudine Lig. Xfmr. ;`� r -'y ,�,5 �
Alarm/Remote Conhol � L1 t� 1 J
Swimming Pool
I here certi that I i�s the elechical installa6on described herein on the dafes stakd
Irrigation Boom Rcw�M� p�
$pecial Inspection
Find
Imestigative Fee �O� �' 2.,.�
THIS INSTALLATION MAY BE ORDERED DISC _ CTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE UsE ONLY This request void 18 monlhs from validation date printed in this box.
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IIIIII�IIIII1011111111111111� � . , o
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* � 4 4 2 9 6 8 4�K PLEASE PRINT OR TYPE
. R�� �°� Rou h-in ins on r uired?
9 P� eq ❑ Yes o Inspection Olher Than RougMn: eady Now ❑�II Coll
�You must call the inspecPOr when ready) Dafe Ready:
I, �licensed conhactor ❑ owner hereby request inspection of the above electrical work at:
�reu . Box, or Roule Nq.� � Cdy � �.� A- �, Zip Code �
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ivL'
Section No. Tovmship ume or No. Ranga No. Fire No. Couny
.- , � r o 1� L.
Phone N O
°� �1 G � c� `� S�
o � s�� � �
12Z42
Electrical Contracror (C N � � r Li �/'1, � Moster Lic. No. (Plant Elec1. Only) .
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ing Addr �Conlrafir or Own Performing I ' .
Authon n re(C �or Performi Insfallation��� � � �
"� ► � o No.,�e.., � �
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EB-00001�411 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY