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P - 83149REGIUEST FOR ELECTRICAL INSPECTION ����''i`� /I Q� Minnesota State Board of Electricity �L �'f �� �a 1821 University Ave., Rm. S-128, St. Paul, MN 55104 ` Phone (612) 642-0800 � Home Duplex Apt. Bldg. Other. / �` ��� New Commercial Industrial Farm � � Remoc Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: Dryer Range Elec. Heat Temp. Service "X" above the work ov red b this request. Ent remarks i t is space and on.the back f the white c y ���.� �- � � �. �, � �, . t �� � Calculate Inspection Fee - This Inspection Request will noi be accepted without the correct fee: Other Fee # Service Entrance Size Fee # Circuits/Feeders Mobile Home Park $tall 0 to 00 Amps ` a`�5�� 0 to 100 Amps Sheet Ltg./Traffic Sig. ,46ove 200 Am s Above 100 Amps Transformer/Generator INSPECTOR'S USE ONLY T' �,.. ,� �.�..,r ,�, -'�1: ,j � �.. Fee Sign/Oudine Lig. Xfmr. � � (1 /( � V Alarm/Remote Control ° � �* Swimming Pool I hereb certi that I ins the eleclrical inslallafion described herein on the dates stated Irrigafion Boom Rouglrin „ � Speci6 n pection Final � Investigative Fee � l � TH1S INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. OFRCE USE ONLY Thia roquesf wid 18 months kom wlidafion date prinfed in this box. i �I f 2604� � �i � �����I�I������������ �����N�����I����� ��� :� * � 5 3 2 4 9 3 �F * PLEASE PRINT OR TYPE Request Da�e Rou h-in ins ion r uired$ � Yes g pecf eq ❑ No Inspection O�er Than RougMn: ❑ Ready Now Will Call � (� g (You must call the inspec�or when ready) Date Ready: I, ❑ licensed contractor � owner hereby request inspection of the above electrical work at: Job Address �Sheet, Box, or Route No.) City Zip Ca i� ? a.cc�� � �' �(' � ci �Q 5 .cc Seclion No. Township Name or No. Range No. Fire No. Couny �IW�v� OccupaM Plwne No. �.��v;el �� c l�I�. � g3 q 70� Mailing Address (Conhactor w No. i n�5r�. u�. r�. Owner Performing Installafion) I ph��� � � ATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY �