P - 81329�:�.
�-y� REQUEST FOR ELECTRICAL INSPECTION � �
71 A O [�XC� Minnesota State Board of Electricity +
� 1�+.{ �, O 4T1 1821 University Ave., Rm. 5-128, St Paul, MN 55104 ��
f Phone (612) 642-0800 �-�
Home Duplex Apt. Bldg. O�her�. � K New Addn
Commerciol Industriol Farm kemod Re air
Air Cond. Htg. Equip. Water Hfr. Load Mgm1. Other:
Dryer Ronge Elec. Heal Temp. Service
"X" above f6e work covered by fhis request Enter remarks in tfiis space and on lhe back oF fhe white copy only.
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RLRe55£Sts�
Calculale Inspec/iw Fee - This Inspe
Other Fee
Mobile Home Park Siall
Sheet llp./Traffic Siq.
will no� be occepted withou� lhe mrrec� fee:
e Entrance Size Fee R Circuits/Feeders �Fee
Amps ./ % 0 l0 700 Amps
Trons(ormer/Generalor INSPECTOH'S USE ONLY ��/ ��+ Jm
SignjOulline Ltg. Xfmr. /?a�j/B��'..-£�/'• �'cT 5�37SJ C23'3 �V� f r
Alorm/RemoteConfrol �_. �.� �O-a�'�,''itz'�./'Ze.��%
$wimminy Pool I he�eb cent ihm i�ins ecr�d �he alecvical I olloiion des�dbed harem on ihe d� sloled Z°"
Irrigotion Boom` } uo�9h�i� , .` �T oo�< Zg_� �
Speciallnspecf �
F'��oi � .� Dapyl. z 7� Oc�
Invesiigafive fee J
� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 78 MONTHS.
OFPICE USE ONLY This reqoeslwid 18 months 6om validotion da�e printed in �his bo*.
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PLEASE PRINT OR TYPE
aeq��� ome Ro�h.� ��:�wa� ,eq��,adz �re: ❑ n�o m:���„ o� than ao„ena�. ❑ R�dy niow w�n coll
s� (Vw mun call �he inspecmr when ready� Dme Ready: �
I, � licensed conhactor � ow�er here6y request inspection of the obove electriml work at:
Job Addmss �Sneeq Box, or RoWe No.� Ciy Zip Code
6.29� �vr,e�p.�. A �� �,e..��Y
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Phone No.
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