P - 81523�40-610
Home Duplex
Commercial Industrial
"X" above ihe work
REGIUEST FOR cLECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Apt. Bldg. Other: New Addn
Farm Remod Re air
Water Htr. Load Mgmt. Other: �
Elec. Heaf Temp. Service �
request. Enier remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without ihe correci fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./Traffic $ig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL �
S
Sign/Outline Ltg. Xfmr. �s.�
Alarm/Remote Confrol
Swimming Pool
I hereb certi that I ins ted the electrical installation described herein on Ihe dates stated
Irriqation Boom o_.._� �_ _
- Final
Investigative Fee
THIS INSTALLATION MAY BE ORDERED
�
IF NOT COMPLETED WITHIN 18
OFFICE USE ONLY This requesf void 18 monlhs from validafion date prinfed in fhis box.
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PLEASE PRINT OR TYPE
Request Date Rou h-in ins tion r uired?
9 P� eq ❑ Yes No Inspection Olher Than RougMn: Ready Now ❑ Will Call
3��%� (You must call the inspecfor when ready) Dafe Ready: �� �/J
7
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Roufe No.) City Zip Code
.�36 8 -C'i4P�`!"�C. sT. �/E Frid �
Seclion No. Township Name or No. Range No. Fire No. County
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������ Phone No.
�G�( ��.c.��sar� (�o/a1—S'�J--//So
Power Supplier Address
Eleclrical Conhacfor (Company Name) Conhacfor License No. Ivlasfer Lic. No. (Planf Elect. Only)
l2Ts Bt.ECT�e�c Gto� 5�8�
Mailirg Address (Conhaclor or Owner Performing Insfallafion)
�'7�-0 -�57� veh��✓ Z,.�+..,, . �h � Ss398'
Authorized Signature (Conhacfor or Owner P rming Installafion) -�i [, A Phone No.
V V IV
E�,,�„ a" ''`'° 6'"'° � �i�--yyi 9ao
STATE ARD Y- SEE INSTAUCTIONS ON BACK OF YELLOW COPY