P - 84637�� `'-245
Home Duolex
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity ,
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
. Other: New Addn
Commercial Indushial Farm Remod Re air
ir C Htg. Equip. Water Htr. Load Mgmt. Other.
Dryer Ran Elec. Heat Temp. Service
"X" above the work covered by fhis request Enier remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepied without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/feeders
Mobile Home Park Stall 0 to 00 Amps � to 100 Amps
Street Ltg./Traific Sig. Ab e 200 Am s Above 100 Ai
Transformer/Generator INSPECTOR'S USE ONLY TOT,
$i n/Oudine Lt Xfmr �
Fee
i�
9 9•
Alarm/Remote Control
Swimming Pool
I hereb certi thaf I ins ed the electrical installation described herein on the dafes stated
Irrigation Boom R Mo
Speciallnspecfio � o l 7
Final '
Irnestigative F � ;,.�—_� — �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monfhs from validation date prinfed in this box.
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* 0 4 4 8 2 4 5 L* LEASE PRINT OR TYPE
Request Date R h-in ins ion r uired2 Yes
oug pecf eq ❑ No Inspection Other Than RougMn: ❑ Ready Now Will Call
��-- � (You must call the inspeclor when ready) Date Ready:
I, icensed confractor ❑ owner hereby request inspection of the above electrical work at:
1ob Address (Street, Box, w Route No.� Ci � Zip Code
' � I(.� .S L r.J �..�
$ection No. Township Name or No. Range No. Fire No. Coun
� ►� � K i4
Power Si
Electrical
Phone No.
Addreu
�� e �• Contracfor License No. Masfer Lic. No. (Plant Elecf. Only�
�
or Owner Per(orr�l�on) �
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or er ing Installation� . � Phone No.