Loading...
P - 82990� REQUEST FOR ELECTRICAL INSPECTION -_ J U 4- 613 Minnesota State Board of Electricity � 1821 University Ave., Rm. S-128, St. Paul, MN 55104 1 Phone (612) 642-0800 Home Duplex Apt. Bidg. Other: New Addn Commercial Industrial Farm Remod Re air Air C Htg. Equip. Water Htr. Load Mgmt. Other: Dryer Range Elec. Heat Temp. Service "X" above the work covered by this requesi. Enter remarks in this space and on the back of the white copy only. / Lir�--� i2� Calculate Inspection Fee - This Inspection Reques� will not be accepted wiihout ►he correct fee: Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Mobile Home Park Stall 0 to 200 Amps 0 to i00 Amps Street ltg./Traffic Sig. Above 200 Am s Above 100 Amps Transformer/Generator INSPECTOR'S USE ONLY T` A4,� Sign/Oudine Ltg. Xfmr. � Alarm/Remote Control Swimming Pool 1 cerli thof I ins the eleclrical installation described herein on the da�es sMled Irrigation B Ra,qMo Dare Speciallns ' Investigative Fee F�� -�,- .-�l� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. OFFICE USE ONLY This request void 18 months from validation dale printed in this box. ii�iiiiiiiiiii � !�� IIIIIIII �Illlll���ililll * 0 5 8 4 6 1 3 4* �`3b`3 PLEASE PRINT OR TYPE R�t^ate ��-^� Ro FFin ins j ���� og pec�ion required$ ❑ Yes No Inspection O�er Than RougMn: Ready Now � Will Call � � �You must call the inspec�or when ready) Date Ready: I, 'censed contractor ❑ owner hereby request inspection of the above elecMical work ah Jo Address (Sheef,p x, a Route No.) C�», Z�p C� �� 4 �LTIl� � ! 1�. [.� Sr�S'4�/ Secfion No, Townshi Name or No. Ronge No. Fire No. Counly f'��'.l� L�' � �t�f�' �� Phone No. �v��'�T K��r � � _ s7 Power Supplier qadreu Elechi onhrntor Name .� Contractor License No. AAosfer lic. No. (Planf Eled, Only) - C ��ol4G79 Mailing��ss Con� e�erforming In�fion) ( -/,/J� I�-. ) . a:� ��./ Qj 4C � L L.K�G�f'�/ Authoriz 'gnature ( nhaclor or ing I Ilafion) .,�� :. � Pho No. 4�� .��'�. E&OOQOIA-11 8/96 y�p� gOARD COPY - SEE INSTHUCTIONS ON BACK OF YELLOW COPY