P - 84745�
REQUESTFQR EL�CTRICAL INSPECTION �_
4 9 i' � 0�`F Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
` Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New ddn
Commercial Indusfrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmf. Other:
Dryer Range Elec. Heat Temp. Senice
"X" above the work covered by fhis request. Enter remarks in this space and on fhe back of ihe white copy only.
+�►5�-. ��ri �
Calculate Inspeciion Fee - This Inspection Request will not be accepted withoui the correcP 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
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Oudine Ltg. Xfmr. ��4 J��/�� �J"�� s� �crt S•--' - ,�(�
Alarm/Remote Control %` � � ``" ` " ` % ` � `'"' �
Swimming Pool
I hereb certi that I ins fhe electrical insfallafion described herein on the dafes sfafed
Irrigation Boom Rougf�ln Dare
Special Inspect
Final �' }
Investigative Fee � "
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requW void 18 monihs (rom validation dafe printed in fhis box.
����������������������II������������� �/=�''�c� � # ���
�����
* � 4 9 1 � 7 4]� * PLEASE PRINT OR TYPE
Req,u/e�st Dafe Rough-in inspection required? ❑ Yes No Inspeclion Olher Than RougMn: dy Now ❑ Will Call
`� J� .�/, (You musl call fhe inspector when ready) Date Rcwdy:
I, �licensed contractor ❑ owner hereby request inspection of the above elechical work at:
Job Addreu �Sheet, Box, or oute No.� Ci Zip Code
�,� � . -�-� s� r�+ k-�. � � 3�.
Section No. Township Name or No. Range No. Fire No. C
� V !"'�
Occupant Phone No.
�R'�1`-,l.A�u% S7ol - �'i'1 y�3
Power Supplier Address
Eleclrical Conhacfor �Company Name) Conkaclor License No. Master Lic. No. (Plant Elecf. Only)
�n's I� � �o�t 39
Mailing A dress (Conhactor or Owner Performin Insfallation) `
�l �l l�-'� - C� . � _ ��-1
Au ri (C for or Owner Performing Insfollation,� 5 2� i� Phone No.
f �' T�
E A-1 1 8/9 STATE ARD COPY - SEE INSTRUCTIONS ON BACK OF VELL�W C�PY