P - 83959REQUEST FOR ELECTRICAL INSPECTION �- ��.
4(' �� n r� Minnesota State Board of Electricity
7 J�? 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612) 642-0800
Home Duplex Apt. Bldg. Other: ew Addn
Commercial Industrial Farm Remod Re air
Air Cond. tg. E' Water Htr. Load Mgmt. Other:
rye /" Rang f( Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on ihe 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 Stoll to 0 Amps � � 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR�s use oN�v TOT
Sign/Outline Ltg. Xfmr.
Alarm/Remote Confrol � S �
Swimming Pool �� Z_ ��- s�-�
I hereb certi that I ins ted the elechical installation described herein dates �/
Irrigation Boom RougMn D.)e
c..,.,.:,.i i...........: - _ %� / Z— �,f?— f �
� Investigative Fee ' "( V ( � '� � �,�_�_ I � -S ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This requesf void 18 moMhs from validation date prinfed in this box.
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* � 4 9 8 9 6 2 ��k PLEASE PRINT OR TYPE �� '�
Reques(t Date Rough-in inspecfion required? es ❑ No Inspection Olher Than RougMn: ❑ Ready Now ill Call
lU� � � (You must call fhe inspecror when ready) Date Ready:
I, icensed contractor ❑ owner hereby request inspection of the above elecfrical work at:
Job Address (Sfreef, Box, or Route �lo.) City ` Zip Code
O t� sre.v� �' � � �e
Secfion No. Township Name or No. Range No. Fire No. Coun
f-��►� ►� t '
Occupan Phone No.
�o� �.,�.i�t�
Power Supplier A Address
J V � �
Eleckical Conhactor (Company Name) Conhacfor License No. Master Lic. No. �Plant Elecl. Only�
nna�i��9
CA00381
463-3f310
256�