P - 84144REt�UEST FOR ELECTRICAL INSPECTION __
5[� ��`� 7 L`^ Minnesota State Board of Electriciry
V , �� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
/ Phone (612) 642-0800 ` '
Home Duo� I� A�—I t.�Other: ewl Addn
Commercial I I Industria
��
Farm Remod
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this space and on ►he back of ihe white copy only.
Calculate Inspection Fee - This Inspection Request will not be accep►ed without the correci fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall to 00 Amp J` 0 to 100 Amps
Street Ltg./Traffic Sig. Abo e 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY T TAL _
Sign/Outline Ltg. Xfmr. ��
Alarm/Remote Control � � r �
Swimming Pool � v � ` ` �
I hereb certi fhat I ins ted ihe elechical insfallation dexribed herein on fhe dates stated
Irri ation Boom
9 Rough-In _ �a�
Special Inspection � �� ~
Final � �4lfy , S �
Investigative Fee ""�'�— � l
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 1 B mon}hs from validation dafe prinfed in this box.
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II II III III II III I III II III II III N III I IIII �^
* �'S 6 6 9 7 6? * �
���PRINT OR TYPE o27DoZ C��
�Request Daf Rou h-in ins ecfion re uired? Yes
g p q ❑ No Inspection Other Than Rough-In: ❑ Ready Now Will Call
` ,_ (You must call fhe inspector when ready� Date Ready:
I, licensed contracfor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Bo r Roufe No.) City Zip Code
�
�y
Section No. Township Name or No. Range No. Fire No. County � �
m
Phone No.
Address
k�J4nF�1('i, INC. CAOG381 I Contractor License No. I Masfer Lic. No. (Plant Elect.
T� jT W., FG TA1., Rr1N 55024
.,.,.,.
or Ow r PerForq�ing nsta a ion)
IAufhorized Signature �Confracfor or Owner PLrforming Insfallafion� I Phone No.
EB-00001 A-1 1 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY