P - 84180REQUEST FOR ELECTRICAL INSPECTION - ��..
���— 4 8 3 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
1 / '
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
"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 noi be accepied without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps . C,L'
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
$ign/Outline Ltg. Xfmr. �� ��
Alarm/Remote Confrol �� � L/
Swimming Pool
r�
I hereb certi that I ins ed the elecfrical ' sfallafion described herein on the dafes sfaTed
Irrigation Boom RougMn par� , �
Speciaflnspecti � �/� � l�
Final
Investigative Fee"' � Do �2-�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHI 1 MONTHS.
OFFlCE USE ONLY This requesf void 18 monihs from validation daie printed in fhis box.
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I IIII II III II II) II III II I III II III II II) I IIII `�� �
* � 5 3 2 4 8 3 �# PLEASE PRINT OR TYPE ��G �
Request Da� /-/ /a� Rou ffin ins fion r uired? Yes pecf q/❑ Ready Now Will Call
L f �j� 9 P� eq ❑ No Ins wn Ofher Than Rou h-In:
/ l (You musf call the inspector when readyJ DaFe Ready: ��
I, ❑ licensed contractor owner hereby request inspection of the above electrical work at:
Job Address (Sfreef, Box, or Roufe No.) Cify Zip Code
7�� /��o �.►i l�� � ��.v �--�� ,,S'".� 3�
Section No. Township Name or No. Ra ge No. Fire No. County -
Occu nt Phone No.
�° ��/.O , %l-��i� �„✓ .s ? l �— ,z �
Power Supplier Address ,/� /� �/
/�� � / � '' `cs /�' � /G1� i i",-.
Elechical Contracfor (Company Na�ne) C frador License No. Master Lic. No. (Plant Elect. Only�
�` (_ � % �-�c lU
Mailing Address (Conka� r"Owner Performing Installation)
n .�-f+? 71 �
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY