P - 83960� ��%��3
Home
Commercial
Air Cond.
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
New
..,..........
.�: `�..
:� :�;;�-�:; �
._
•.,: �1}
•::.�.
��
Industrial Farm Remod
Htg. Equip. Water Htr. Load Mgmt. Other:
Rang Elec. Heat Temp. Service
overe y this request. Enter 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 # Servi e Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0. to 00 Amps � ro 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPEC70WS USE ONLY TOTA6 �
Sign/Outline Ltg. Xfmr.
Alarm/Remote Conhol
Swimminq Pool ,
installation described herein on fhe dates stafed
Dafe
�. � .�� — //� `...
Investigative Fee �. _�`I�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months 6om validation date printed in this box.
�������II����I�i�� • �����
I I II iil Il�l l II I II II II I i II I
I ,�-
* � 4 9 8 9 6 3 8* LEASE PRINT OR TYPE �L%'�
Request Date Rough-in inspection required? es ❑ No Inspection Othei lhan RougMn: ❑ Ready Now 0 Will Call
��� � � (You must call the inspector when ready) Dafe Ready:
I, icensed confractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheef, Box, or Route No.� City ` Zip Code
C a� CH�2csT�is C.�'- ����c.e
$ection No. Townshio Name or No. Ranae No_ Fire No. Cnunw
�Zl'Lc,�il� �
Power $upplier
���
e��n��o� co�o-�.`'f�l��„�„�NC�F��C, INC.
310G-225Tii oT. W., F� ;
Mailing Address ( onfractor or r Perforrr�3
� �
Authorized Si, aNre �Conk r or Owner P
�en n�,��
Phone No.
I Conhacfor License No.
CA00381
2�6�
�TRUCTIONS ON E
Master Lic. No.
No.