P - 81994RE(�1UEST FOR ELECTRICAL iNSPECTION
G� 0�� 2 4 7 � Minnesota State Board of Electricity
1821 University Ave., Rm. S-1 �� t. P�yl, MN 55104
"' Phone (612) 642-0800 � t���
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm ���Q' �� Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Ot er:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of t�e white copy only.
,�TCiG� G1•/'GJ{ I � �� �%��5�/ILJ� J�QY�%1G; �
I rv �a ra� � b � 1-E- `t � Sa rv .�.. cy c� �
Calculate Inspection Fee - This Inspection Request will noi be accepied withou► the correct fee:
Other Fee # Service Entrance Size Fee # CircuitsjFeeders Fee
Mobile Home Park Stall 0 to 200 Amps S' 0 to 100 Amps d
$treet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR's uSE ON�Y TOT �'`
SignJOutline Ltg. Xfmr. � �Q�� J�
Alarm/Remo t
Swimming Po
I hereb certi that I ins ecfed the elxhical insfallafion described herein on rhe dales sMted
Irrigation Boom Rough-In Dare
Special Ins ection
Final
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTH .
OFFICE USE ONLY This �squest void 18 months from validation date prinfed in fhis box.
IiNIIlffllillllllllflllflllll�IIIIIIIiIfIIIII - •
* 0 8 0 2 2 4 7'? * ��'�� �� �/�3
PLEASE PRINT OR TYPE
Req�esf Dafe Rough-in inspection required? ❑ Yes ❑ No Ins on OlFier Than Rou h-In:
pec�i g ❑ Ready Now Will Call
�i pZ4 �! (You must call the inspector when ready� Dote Ready:
I, ❑ licensed contractor� owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Route ) �. Ciy Zi Code
%3 SB�b�FS�;/U�r� �ric� e �Sy3�.
� Section No. Township Name�sr.No. Range No. . t Fire No. Counry
0�0 0� � Oc�1�I
a��,,� � � . �c3�r c, �,�,eb.�_7 8 y--1350
Power Suppli � Add s
�S �lL� �( ����Sid�
Electrical Co r(Company Name) `=' � Conhacror License No. Master lic. No. (PIaM Elecl. OnlyJ
' V
Mailing ess r or Owner Performing InsMllallon)
Aufhori SignoNre (Conhacfor er P {�ing Insfallafion Phone No.
6�•7�sY- r��c�
EB-00001 A-11 8/9 STATE 80ARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY