P - 82106REQUEST FOR ELECTRICAL INSPECTION ��
8 0� ��� J � Minnesota State Board of Electricity `�
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �`
° Phone(612)642-0800 "�'
Home Duplex Apt. Bldg. Other: �, c� �. New Addn
Commercial Industrial Farm � pl!„ ' Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. $ervice
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps � 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL ��
Sign/Outline Ltg. Xfmr. '
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins the eleckical in afion described herein on the dates stafed
Irrigation B Rough-In �i Da
Special Inspection �� �Z`� �
Final �ek� ! —_ �
Investigative fee F /'
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 months from validafion date printed in fhis box.
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PLEASE PRINT OR TYPE
Reques te Rou h-in ins fion r uired? �Yes pecti g ❑ Ready Now ��II Call
�� r O Q g pec eq ❑ No Ins on Other Than Rou Mn: .
�You must wll the inspecror when ready) Date Ready:
I, ❑ licensed contractor �owner hereby request inspection of the above electrical work at:
Job Address (Shcef, Box, or RouM No.) Cily Zip Code
Io �-\ C�a..r'o � l�s� �t-� c� ` SS�-3�-
Secfion No. Township Name or o. Ra� No. Fire No. CouNy
7�C�
Occupant Phone No.
S�-•�N���- t �uv�i 1 �iv�sn.u,�ss.e.l� '�Io'.�--�-�7�--11oE�y-
Power Supplier Addreu
�is � �+1� 1�� c�l i�e.'i S 1u��1
Elechical Conhacb . ompany Name) _ Conhacfor License No. Masfer Lic. No. (Planf Elecl. Only)
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Mailing Address �Conh r or Owner Performing Insfallafion) �►�y � r� �
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Aufhorized SignaNre �Conhador oc Owner Performing Inslall ' Phone No.
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EB OOOOI A-11 8/96 �p� gOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY