P - 80447> REQUEST FOR ELECTRICAL INSPECTION
� U�- 2 8 5� Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
` Phone (612) 642-0800 `��
Home Duplex Apt. eldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Ra�ge Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
(.�/�!� � 7o f�0 T 7-� XS .
Calculate Inspection Fee - This Inspection Requesi will not be accepied without the correc� fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 200 Amps 0 t A
Street Ltg./Traffic Sig. A ove 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL�J /
Sign/Oudine Ltg. Xfmr. `� ( �S�
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins the elechi installafion described herein on the dates staAed
Irrigation Boom RougMn re
Special I�spectio� � � — � �
Final �,
Investigative Fee
THIS INSTALL!►TION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 months from validation date printed in this box.
I III) I� I�I �� I�� II III II III II III Il I�l I� lIl ��{�I
* 0 8 0 2 2 8 5 7* ��7�� ���
PLEASE PRINT OR TYPE
Requesf Dafe RougMin inspeclion required2 �Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now �f Will Call
Q> — D r (You must call the inspeclor when ready) Date Reody:
I, ❑(icensed contractor �owner hereby request inspection of the above elechical work at:
hb Address �Street, Box, or Route No.� Ciy Zip Code
�e�$s c�T��� �v� �v� f= �dG� 5.5��32
Section No. Township Name pr No. � . Range No. Fire No. C nfy
o � f4ivvk,�
Occupant Phone No.
S%Q/� l�`�S�fr`�4z %b 3%$�" g�f6 7
Power Supplier • �Addrese
L-'�c€�L ` /�!/�LS �liolZ?�f !�� `(ii;sr'b�/
Elecfrical Conkactor (Company Name) Conhactor License No. Master Lic. No. (Plant Elect. Only)
�Conhactor or Owner Performirg Installation�
�,�r� �
iture on cror or Owner P ing I stallation) Phone No.
� 76�--��'6^S'�,6
/96 STATE BOARD COPY - SEE INSTRUC710NS ON BACK OF YELLOW COPY