P - 80667REQUEST FOR ELECTRICAL INSPECTION
5 3 c��J l� �F Minnesota State Board of Electriciry
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Hig. Equip. Water Htr. Load M mt. Other: i� 1 /
Dryer Range Elec. Heat Temp. Service �) `Ntl k �/.i��"1 � 1'"I
"X" above the work covered by ihis request. Fnter remarks in this space and on the b of tl�e white copy only.
,�715�
Calculafe fnspeciion Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/feedt
Mobile Home Park Stoll 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100
Transformer/Generator INSPECTOR'S USE ONLY TC
Sign/Oudine Ltg. Xfmr. � t?��L V-'=,��"
Alarm/ m t C tr I ��° `��
l
Fee
e oe on o �v � � �,T,
Swimming Pool �l ��" 3�0 1C1(� �'� ZY'tJa
1 hereb certi that l iris ed the elechical installaAon described herein on �e dates sfated
Irrigation Boom RougMn �;p` ` Da�! � �'`S
Speciallnspection ��r �E���1
Fioa� � L�G�CJ
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONN TED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request wid 18 months kom validation do�e pri�ted in this box.
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* � 5 3 2 5 8 4 ��K PLEASE PRINT OR TYPE
Req�D � � RougMin inspection required? ❑ Yes ❑ No Inspecfion O�er Than RougMn: ❑ Ready Now Q Will Coll
(You must call 1he inspecfor when ready� Date Ready:
I, ❑ licensed conhador �owner hereby request inspection of the above elechical work at:
bb Address (Street, Box, or Route No,) Ciy � Zi Code
�h d � � �'�
Seclion No. Township Name or No. Ranae No. Fire No. _
Power
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,�d `7��3��
Nome)
(Conhacfor w Owner
Phone No.
STATE BOARD COPY - SEE INSiIiUCiIONS ON BACK OF YELLOW COPY
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No.