P - 831445�VV-984 �
Home Duplex
1 "X"
REGIUEST FOR ELECTRICAL INSPECTION =�
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Other: New Addn
I Industrial Farm Remod Repair
Htg. Equip. Water Htr. Load Mgmt. Other:
Range Elec. Heat Temp. Service
work covered by this request. Enter remarks in this space and on
of the white copy
Calculate Inspection Fee - 7his Inspection Request will not be accepted wifhout the correct fee:
Other Fee # Servic Entrance iz Fee # Circuits/Feeders Fee
Mobile Home Park Stall to 0 Amps 0 ro 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator IN � CTOR'S USE ONLY TOT� ���
Sign/Outline Ltg. Xfmr. �
Alarm/Remote Control
Swimming Pool
I hereb certi thal I in Ihe eleclrical installation deuribed herein on ihe da�es stated
Irrigation Boom RougMn .�-
Speciallnspection � � �
Final _ �/
Investigative Fee Ti
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHI 18 MONTHS.
OFRCE USE ONLY This roquest void 18 months 6om validafion date printed in this box.
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* � 5 6 6 9 8 4 1* pLEASE PRINT OR TYPE
Requesf Da Ro fFin ins tion r uned$ Yes
2 ug pec eq ' ❑ No Inspeciion O�her Than RougMn: ❑ Ready Now Will Call
J ', �� �You musf call the inspector when ready) Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Ad ress (Sheef, Box, or Roufe o.) Cily /� Zip Code
�"�% ��`-�f � 1 a7 � �:�„ � �• �./� �
Seclion No. Township Name or No. Range No. Fire No. County
nt � � �/� !�\�� - Phone No.
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tlechirnl Conhactp��y,p��'C, INC. CA00381 Contractor License No. Master Lic.
tli 1 fi
3100-225T'ri ST. W., FG TN., MN 55024
Mailing Address �C kaclor or Own PerFormi �
► a
Authorized Sign re �Confracf or Owner Pe ing Insfallafion� Plrone No.
Eg00001 A-i l 8/96 STATE BOARD COPY - SEE INSTAUCTIONS ON BACK OF YELLOW COPY