P - 82836RE(IUEST FOR ELECTRICAL INSPECTION
6��� 7 3 5� Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
- Phone (612) 642-0800 "°�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
' Cond. tg. Eq i. Water Htr. '.ad Mgmt. OTher:
Dryer ange ' j Elec. Heat _ Temp. Service
"X" above e work covered y this request. Enter remarks in this space and on the back of ihe 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
Mobile Home Park Stall to 00 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 _Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAT� �
$ign/Outline Ltg. Xfinr. ��{
Alarm/Remote Control
Swimming Pool 1 hereb certi that I ins the electricol insmllafion descri6ed herein on 1he dates staled
Irrigation Boo Ro�,gMn , �r�
- - , . . �/, — �, �� 9'.- c- -
Fee
�r
Investigative fee ��- 22 O
THIS INSTALLATION MAY BE ORDERED DISCONNEGTED IF COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This req t void 18 monfhs from validation dofe printed in fhis box.
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PLEAS PRINT OR TYPE
R � Rou h-in ins Fon r ired$ es
g pec eq� ❑ No Inspection Other Than RougMn: ❑ Ready Now Will Call .
� (`/ou must call the inspector when ready� Date Ready:
I, licensed contracFor ❑ owner hereby request inspection oF the above elecfrical work at:
1ob Addr u.�Sheef, Box, w Routc �� Zip Code
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Sedion No. I Township �� �.._ . i n-_,.� .vo. + Fire No. �+_ % `
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Phone �.�� ...
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Pc� Address
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cl� .•: ical :onkacror ��ompany Nr.me( ���S FLFCTRIC, �i�C Contractor�c,�y�,j;�g
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310G-22�Tii o^T. W., F TN.. ti1N 55024
Mailing Address �Confractor or pwner Performin Instollofion) �
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Authorized Signafure (Conhactor or Owner P ing Inslal tion)
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No.
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1 A-11 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY >