P - 82804677�=719 �
Home Duplex
Commercial Industrial
Air C Htg. Equl
Dryer Range
"X" above fhe work covered 6
REGtUEST FOR ELECTRICAL INSPECTION ���
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �`
Phone (612) 642-0800 `�'
Apt. Bldg. �ther: ` fi 1,���� New Addn
Farm (/ Remod Re air
Water Htr. Load Mgmt. Other: �
Elec. Heat Temp. Service
request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepied without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits
Mobile Home Park Stall 0 to 200 Amps 0 to 100 A
Street Ltg./Traffic Sig. Above 200 Am s Above l Od
Transformer/Gene�ator INSPECTOR°S USE ONLY
Sian/Outline Lta. Xfmr.
Fee
�
Swimming Pool
I hereb certi that I ins fhe eleclrical inslallafion described herein on ihe dates stated
Irrigation Boom R,,,g�,.�„ pa�
Special Insp
Date r
Investigative ee Z-'Z�'�/
THIS INSTALLATION MAY BE ORDERED DiSCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months 6om validation date printed in this box.
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* 0 6 7 7 7 1 9 7* �� 7G�
PLEASE PRINT OR TYPE
Request Date Rough-in inspection required? ❑ Yes o Inspection O�er Than RougMn: dy Now ❑ Will Call
�You must call the inspector when ready) Dote Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address Sheet, Box, o Rou1e No.) � Zip C
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Secfion o. Township Name or No. Range No. Fire No. Couny
Occupan Phone
Address
A-11
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�Com y Name) Conhador License Mas � Lic. No. ��nf Eli
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(Conhac� Owner Pe rmin Insfallafi ^^ L/� /J�/� �
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iNre C ha ner Perfor g Insfallafion� ' Phone No.—��
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/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY