P - 83151REf�UEST FOR ELECTRICAL INSPECTION
G` ���� (] /I � � Minnesota State Board of Electriciry
�� �- ��� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
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Home � � Duplex
Commercial Industrial
w�,� £
Farm
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
is request. Enter remarks in this space and on
� -�— A-Jci
New
Remod
copy
Calculate Inspection Fee - This Inspection Requesi will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders F
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps i/'
Sfreet Lig./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR�s use oN�r TOTAL r/�
Sign/Outline Ltg. Xfmr. _ 2 �� /� � ���f
Atarm/Remote Control �F
Swimming Pool
I here cerli that I ins the elechiwt installafion described herein on The dales slatad
Irrigation Boom RougMn Da�e
Special Inspection
Final Dptg � v 1 y
Investigative Fee Y� f�
THIS INSTALLATION MAY BE ORDERED DlSCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
-� __ - --___ __— ------
OFFICE USE ONLY This request void 18 months from validafion date printed in this box.
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�4l �Zj II�ASE PRINT OR TYPE
Re�st�°fe Rough-in inspecfion required$ ❑ Yes � No Inspection Ofher Th n Rough-In: Ready Now ❑ Will Call
+% (You must call the inspector when ready� Date Ready: '� �
I, �licensed controctor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheef, Box, or Route No.) Ci Zi Code
� � ,�i' � d S'�ta �.
Section No. Township Name or No. Range No. Fire No. Couny
Occupant
roWa� s�G
.hical Contracror (Company Name)
SPARK �L�CTRIC
iling Address (Conkoctor or Owner Performing Insta
2114 �VAS INGTON ST , �
horized SignaNre Con r or Owner Pe� �rmii►y
V _
OOOIA-11 8/96 STATE BOARD (
Phone No.
�?t�
Conhacror License �
CA01700
! I
- SEE INSTRUCTIONS ON BACK OF YELLOW COPY
lic. No.
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1