P - 844934���-920
Home Duplex
Commercial I ndustria l
Air Cond. Htg. Equi
Dryer Range
"X" above the work covered b
REGIUEST FOR ELECTRICAL INSPECTION - - �..
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Apt. Bldg. Other: New Addn
Farm Remod Re ir
Water Htr. L Mgmt. Other:
Elec. Heat Temp. Service
this request. Enier remarks in ihis space and on the back of the white copy only.
Calculafe Inspection Fee - This Inspection Request will not be accepted without the correcf fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
$treet Ltg./Traffic Sig. Above 200 Am s Above 100 Am
Transformer/Generator INSPECTOR'S USE ONLY TOT�1
Sign/Oudine Ltg. Xfmr. �S
Alarm/Remote Confrol
Swimming Pool
Fee
I hereb certi that I ins the elechical installafion described herein on ihe dates sfated
Irrigation Boom RoogMn pa�
Special Inspection
Ffnol Dare
Imestigative Fee �l�_
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONT .
OPFlCE USE ONLY This roquesf void 18 months from validaHon date prinfed in this box.
��1
IIIIIIIIIIIIIIIIIIIIIIIIII�III II II ����� _ �
� � ������������ ,���-
* � 4 � 0 9 2 0 5* ASE PRINT OR TYPE
Request Dafe RougVfin inspecfion required$ es ❑ No Inspecfion 01her Than RougMn: ❑ Ready Now ill Call
�You must call the inspecfor when ready) Dafe Ready:
I, icensed confractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Shcet, Box Roufe No.� City Zip Code
�{ �� %?�l.t'JL...�
Secfion No. Township Name or No. Range No. Fire No. Couny
��P° Phone No.
,(� l7'?�iri�
37�('i-22Jr�'1'� j� {N�
Address ( cfor or Own Perforn
%v
ed Signature (Caifracfor or Owner Pe
IA-11 8/96 STATE E
CA00381 Contractor License
�N 55024
25U4 fi
IUCTIONS ON BAC6
Lic. No. �Plant Elect.
No.