P - 80129REQUEST FOR ELECTRICAL fNSPECTION �«
:J V�•� 3 5 6� Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 551�4 �
Phone (612) 642-0 0 `��
Home Duplex Apt. Bldg. Other: � New Addn
Commercial Industrial Farm � Remod Re air
Air Cond. Htg. E uip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remorks in fhis space and on the back of the white copy only.
Calculafe Inspection Fee - This Inspeciion Requesi will not be accepted wiihout ihe correct fee:
Other Fee # Service Entranc ize Fee # CircuitsfFeeders Fee
Mobile Home Park Stall 0 to 00 ps � 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps �
Transformer/Generator INSPECTOFi'S USE ONLY TOTAL D
Sign/Outline Ltg. Xfmr. ���
Alarm/Remote I
Swimming Poo
I hereb certi that I in fhe elechical installafion described herein on the dales stated
Irrigation Boom RoogMn _ Z 6^Q_,�
Special Inspection
Final _ ���
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHfN 18 MONTHS.
. OFFICE USE ONLY This requesf void �months (rom validation date printed in this box.
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* 0 8 0 2 3 5 6 6* � ���
PLEASE PRINT OR TYPE
Request Dofe �J Rough-in inspecfion requiredZ ❑ Yes o Inspection Ofher Than RougMn: ❑ Ready Now �rCall
�'�,3 j���/�/ (You musf call the inspeclor when ready� Date Ready:
I, ❑ licensed contractor L�owner hereby request inspection oF the above elechical work at:
Job Address (Sheet, Box, or Roufe No.) Cily • Zip Code
��8a ��u �r,v�. �,e���y �-���.
Secfion No. Township Name or No. Range No. Fire No. County
�i O O'� � �IL/�
Occupant �j
��r� � �►/'cC/ti .ri � Ph�lz"�%�—CJQ�
Power Supplier Address • • .
1(��--- • /�? ��5 • �m . %� � u6.5lo.c�
Elechical Contractor �Company Name) Conhacfor License No. AAaster Lic. No. (Manf Elecf. Onl�
N
Mailing Addreu (Conkacfor or Owner Performing Insfallation�
Authorized Signature (Conhactor or Owner Performing Insfallafion� Pho� No.
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EB00001 11 y�p� gOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY