P - 80138REQUEST FOFE ELECTRICAL INSPECTION �`
�(� Z�� C� � Minnesota State Board of Electricity
�l `'� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: p�� ew Addn
Commercial Industrial Farm �%�/� �? � Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: .Q� 21%1
Dryer Range Elec. Heat Temp. Service `%Q-/
"X" above the work covered by this request. Enter remarks in this space and on the back of ►he white copy only.
Calculate Inspeciion Fee - This Inspection Request will not be accepted 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
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generaf PECTOR'S usE ON�v TOTAL se-��
Sign/Outline Ltg. Xfmr. ��
Alarm/Remote Conhol
Swimming Pool
I hereb certi thaf I ins ihe electriml insMllafion described herein on the da�es stated
Irrigation Boom RougMn � ( '
Special Inspection �� Q �� � �-`
Final Dafe.
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void �B`months Irom validafion dafe prinled in this box.
( I�I� �) �I� I) ��� �) ��) �� ��� N I� ����� I� ��� � � � �
* 0 8 0 2 3 5 4 1* �y ��,Sb
PLEASE PRINT OR TYPE
Request Date Rough-in inspecfion required$ es ❑ No Inspeclion Other Than Rough-In: ❑ Ready Now �II Call
� �o 'j/� �You musf call ihe inspector when. ready) Dafe Ready: '
I, ❑ licensed contractor �owner hereby request inspection of ihe above elechical work at:
lob Addreu (Sheet, Box, w Route No.) City Zip Cade
1�.�' ?�� D� 6vA� �i2i ��� S'.�Sf 3 Y
Section No. Township Name or No. Range No. fire No. Couny
30 29R � � �-`f �4 N o k�--�
Occupanf
l� � M f� 'e t�
: e- � �
(Compan Name)
�G �
ihodor w Owner PerForming Installofion)
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IContrc�or or OwneuP�formind Inst�lk
STATE BOARD COPY - SEE
Confracior License
Phone No.� � ^� � ` ^ ���
7 �
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ON BACK OF YELLOW COPY
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