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P - 80225,� • REQUEST FOR ELECTRICAL INSPECTION �_. ��. j--- ��°� � 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: New Addn Commercial Industrial Farm Remod Re air Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: Dryer Range Elec. Heat Temp. Service "X" nbove ihe work covered by this request. Enier remarks in this space and on the back of the white copy only. y�� , �G�fiit� ��¢�rwaol.�-�..�v�, .�'��'��, ba,�=i�G�< � �� ��co� Calculate Inspection Fee - This Inspeciion Request will not be accepted without ihe 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/Generator INSPECTOR'S USE ONLY TOT L 1 Sign/Outline Ltg. Xfmr. �" Alarm/Remote Control Swimming Pool I hereb cerTi that I' cted the electrical installation described herein on the dares stated Irrigation Boom RougMln Da�e� Special Insp i+ - r �_�� Fdaal� Da Investigative "'Z- F � THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. OFFICE USE ONLY This request wid 18 months from validation date printed in lhis box. � �i�l �� �II �� ��� �� ��� �� ��� �I ���I� ��� ��II •�-� * 0 7 7 2 9[� 3 5* S�� � PLEASE PRINT OR TYPE Request Date Rough-in inspection required$ ❑ Yes No Inspeciion Other Than Rough-In: ❑ Ready Now �� Will Call I�as �� (You must call the inspedor when ready) Date Ready: �� 3.� vO I, '�licensed contractor ❑ owner hereby request inspection of the above elechical work at: •• Job Address (Street, Box, or Roule No.) Ciiy � Zip Code �- � 1�10�. ` Q 5 Z $ecfion No. Township Name w No. Range No. Fire No. � Power $upplier J � Address Elechical Conhactor �Company N � ContraMOr License p�u��tf�or�d eleEtri� inc. !�� � !M� Mailing Address (Conkackk or u' w�' i �fne�polity � 55410 , �'� Phone No. ����-/� or r r rrormmg instananon) /. � � a.{ J rnone rvo. `pk(T nI V h� , �ia�-?1� STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY