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P - 83492. REQUEST FOR ELECTRICAL INSPECTION ����� Q Q Minnesota State Board of Electricity V`� 1821 University Ave., Rm. S-128, St. Paul, MN 55104 Phone (612) 642-0800 Home Duplex Apt. Bldg. Other: New ommercial Industrial Farm Remod Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: Dryer Range Elec. Heat Temp. Service "X" above the work covered by this request. Enier remarks in this space and on the back of the white copy only. �og� l��'1 �� Calculate Inspection Fee - This Inspection Request will not be accepted withoui the correci fee: Other Fee # Service Entrance Size Fee # Circuits/Feeders Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps Street Ltg./Traffic Sig. Above 200 Am s Above 100 Am Transformer/Generator INSPECTOR'S USE ONLY TO Sign/Outline Ltg. Xfmr. Alarm/Remote Control Swimming Pool I hereb certi thaf I ins ecfed the elecfrical installafion described herein on the dafes Irrigation Boom ,,,,,,,,,,_ _ Fee THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WIT_HIN 18.MQ HS.__ __� OFFlCE USE ONLY This request void 18 monfhs from validation date prinfed in this box. iii�ii�ilioiiliiiiiii�iiiiiiiiiiiiliiioi� �. `ls'� * 0 6 4 7 6 8 9 9* �t�o�J� PLEASE PRINT OR TYPE R�t D=}e '� Rough-in inspection required$ ❑ Yes o Inspecfion Ofher Than Rough-In �You musf call the inspecfor when ready) Dafe Ready: ✓ I, icensed contractor ❑ owner hereby request inspection of the above electrical work at: Job Ad ress (Streef, Box, or R fe No ) City `� �lZ la� n I i� Secfion No. Township Name or No. e No. Fire No. oup1K _ � $upplier Mailin Address jConhacfor or Owner Pel'Forming Insfallation) uthorized Signature (C tracfor or Own P orming Insfallation� �� 2 �� . .:� EB-00001 A-11 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BAi Lic. Now ❑ Will Call /�.�,