P - 83232r
5���993 ��
Home Duplex
Commeraal Industrial
"X" above the
_ _ , �� � _
REGIUEST FOR ELECTRICAL iNSPECTION -
Minnesota State Board of Electricity
182t University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Apt. Bldg. Other: New Addn
Farm Remod Re air
Water Htr. Load Mgmt. Other:
) Elec. Heat Temp. Service
this requesl. Enter remarks in this space and on the back of the white copy only.
Calculate lnspection fee - This Inspection Requesi will not be accepted withouf the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall ro 00 Amps J 0 to 100 Amps
Sheet Ltg,/Traffic $ig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TQT/�,,. �
Sign/Outline Ltg. Xfmr. � � ri� )C./
Alprm/Remote Conhol
Swimming Pool
I hereb certi thot I ins the elechical in Ilafion dexribed herein on the da�es stated
Irrigation Boom RougMn Date Q
Special Inspect �" ' T
Final �/
Invesfigative Fee p
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITFFIN 18 ICIffONTHS.
OFFlCE USE ONLY This raquest void 18 months Gom volidalion dote p�inted in this box.
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* 0 5�a 6 9 9 3 2 �k PLEASE PRINT OR TYPE ���
Requesf fe Rough-in inspection required$ Yes ❑ No Ins on
pecli O�Irer Than RougMn: ❑ Ready Now Will Coll
� (You must call the inspeclor when reody) p� g�,.
I, licensed contractor ❑ owner hereby request inspection of tlie above elechical work at;
Job Address (Sheet, Box, or Rou�e N.)
Ciy Zi Code
tQl /t �� �,_ n n P � i , n n a
I Secfion No. �Township Nome or
�� � �c� t�eCTRIC, INC. CA00381
310G225TH ST W„ FC !" .,�Ati sM
Address �Connh-actor or Owner PerFormi��1��)
M�F_ _ 0 i` •
Fire
Piwne No.
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW CQpY