P - 83141REGIUEST FOR ELECTRICAL INSPECTION -u��..
5 C? U- 9 81 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
`/ Phone (612) 642-0800 /
� Home Du�lex A�t. Blda. Other: �� New � � Addn �
ommercial I strial Farm Kemod
' Con Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above t e work covered by this request. Enter remarks in this space and on the back of the white copy
Calculate inspection Fee - This inspection Request wiil not be accepted without the correci fee:
Other Fee # 5ervice Entrance Siz Fee # Circuits/Feeders Fee
Mobile Home Park Stall to 0 Amp 0 to 100 Amps
Street Ltg./TrafFic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY 70T�� �
Sign/Outline Ltg. Xfmr.
Alarm/Remote Confrol
Swimming Pool
I hereb certi that I ins the eleclri ' smllafion dexribad herein on the dates stafed
Irri9ation Boom u��..�„ _ ��:1 oar�_ .. /
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 months from validafion date prinled in this box.
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* � 5 6 6 9 8 �+ 7* PLEASE PRINT OR TYPE
Request Dafe Rou h-in ins ion r uired? Yes
3—����/ g pect' eq ❑ No Inspection Olher Than RougMn: ❑ Ready Now Wilf Catl
o (You must call the inspec�or when ready) Date Ready:
1, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, w Route No.) Ciry Zip Code
to �► � �. �rrc� 1 �.0
I Secfion No. I Townshio Name or
I Power
Phone No.
ny Name) . . I Confractor license No. I Mashv Lic.
iLECTRIC, INC. CA00381
r7H ST. W.� FGTN_� MN �(�,
or Owner Per{wmiq�)
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-� 1± I Plwne
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STATE BOARD COPY - SEE INSTRUCTlONS ON BACK OF YELLOW COPY