P - 827325�r-487 �
1
✓ Commercial Indushial
Air Cond. Htg. Equl
Dryer Range
"X" above the work covered b
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 "�'
Apt. Bldg. Other: r // New Addn
Farm / v/ !lQ� � Remod Re air
Water Htr. Load Mgmt. Other.
Elec. Heat 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 the correct fee:
Other Fee # Service Entrance Size Fee # ' Circuits/Feeders Fee
Mobile Home Park Stall 0 ro 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s AEiove 100 Amps
Transformer/Generator � P�C7oR's use oN�r ', TOTAL �� C
U J
Alarm/Remote CoMrol '
Swimming Pool
� I here certi tfwf I ins the eleclrical installafion de ibed herein on the da�es slaled
(rrigation Boom M„ , p�
Special Inspection
Investigative Fee Find �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTFIS. _
OFACE USE ONLY This requeat void 18 months from validafion date printed in this box.
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* � 5 9 7 4 8 7 8�k PLEASE PRINT OR TYPE
Re9� � �. Rough-in inspeclion required� .❑ Yes Inspecfion Olher Roug n: dy Now ���I CaN
ar! � g (You must call the inspecbr when reody) Date Ready:
I, licensed conhactor ❑ owner hereby request inspection of ihe above electrica� work at:
bb Address heet, Box, or Route No. Ciy � / Zipi� �^
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Seci�o � No. � Township Nome w No. Ronge No. Fire No. Coun /�
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o«���r ��� � �i L� . 4 /1 Lf� r�«� N�.�� � / �
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Power S P�ier „� �� � � I Y(����L/`�,
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Eledri Con r �Canpairy Na � Contractor license No. Master Lic. No. �Plant Elecr. On�y)
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Mailing dress Conhactor or Owner Performing Installafig�'� /� . �
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Authorized Signalure �Contractw w Owner Performing Inslallation) . .. ... Phone N� ^� .,� //��
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EBOOOOIA-1 1 8/96 �p� g D COPY - SEE INSTRUCTIONS ON HACK OF YELI.OW COPV �