P - 831405���980 ms.
Home Duplex
Commercial Indushi
Air Cond. Htg. Ec
Dryer Range
"X" above the work covered
REQUEST FOR ELECTRICAL INSPECTION �..
Minnesota State Board of Electricity �
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-OS00
Other. New Addn
Farm
Wafer Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
this request. Enter remarks in this space and on
copy only.
Calcvlate Inspection Fee - This Inspection Requesi will nof be accepted withouf the correct fee:
Other Fee # Service Entrance ize Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to OO Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transforme�/Generator INSPECTOR'S USE ONLY TO�� �s�
Sign/Oudine Ltg. Xfmr. U
Alarm/Remote Conhol =
Swimming Pool
I her certi ihat I ins Y ted the eleclrical insfallation described herein on the da�es staled
IrrigatiQn Boom RougMn Dare
Speciallns `
Invesfigative Fee F���
THIS INSTALLATION MAY BE ORDERED ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� OFFICE USE ONLY This roquest void 18 months from validafion date printed in this 6ox.
�► a� -s�
illllllllllililllll llllllliilllll�l�l�l ��o�
* 0 5 6 6 9 8 � 9* PLEASE PRINT OR TYPE
R��S� � Ro Irin ins ion r uiredi es
ug pecY eq ❑ No Inspecfion O�er Thon RougMn: ❑ Ready Now iN Call
'� (Yoo must call the inspector when ready� Date Ready:
I, licensed conhactor ❑ owner hereby request inspection of the above electrical work at:
,�,,� �,a 3, o� R� ��y cJl ( Z,P ��
r
Seclion No. Township Name or No. Range No. fire No. County
Ocyypant _ , , , � Phone No.
I Power
� Mailing Address
ny Nam� - Conkador License No. Master Lic,
5 ElE .TRIC, INC. CA00381
�25T'ri ST. W.. FG TM.. MN .55024
or Owner Performing In�IwiQ� 0
� a
�cfor or PerFomi n Ilafion) /a ' Phone No.
c� t_i
STATE BOARD COPY - SEE INSTRUCiIONS ON BACK OF YELLOW COPY