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P - 82100802--193 � Home Duplex Commercial Industri Air Cond. Htg. Ec Dryer Range "X" above the work covered Calcula►e Inspection Fee - This Insp< Other Fee Mobile Home Park Stall Street Ltg./Traffic Sig. Tra nsformer/Generator REQUEST FOR ELECTRICAL INSPECTION Minnesota State Board of Electricity 1821 University Ave., Rm. S-128, St. Paul, MN 55104 Phone (612} 642-080 Apt. Bldg. Other: —�^ /f' New Farm �l/ �v Remo< Water Htr. Load Mgmt. Other: Elec. Heat Temp. Service request. Enter remarks in this space and on the back of the white copy m Request will not be accepted withoui ihe correct fee: # Service Entrance Size Fee # Circuits/Feeders 0 to 200 Amps 0 to 100 Amps Above 200 Am s Above 100 Ai INSPECTOWS USE ONLY TOT� .!�'%a-� G�j � i /Vh� l^= �f-oz- c � a,�.r -=Jla 1 J�l:�:I7 _- � -- I hereb certi thaf I ins the elecfrical ins Ilafion dexribed herein on the dates stafed Irrigation Boom RougMn Dare Special Inspection + 2"d � D w Investigative Fee �� wc-c� THIS INSTALLATION MAY BE ORDERED DISC OT COMPLETED WITHIN 1 MONTHS. OFFICE USE ONLY This requesf void 18 monihs from validation date prinfed in iiiis box. I�IIIIIIIIIIIIIIIIIIIIIIIIII�IIIII�II�I �e� �p � �`�° � 0 8 0 2 1 9 3 3* ��T PLEASE PRINT OR TYPE Request Date Rough-in inspecfion required$ Yes ❑ No Inspecfion Other Than Roughan: dy ❑ Rea Now Will Call (You musf call the inspeclor when ready� Dafe Ready: I, ❑ licensed contractor �owner hereby request inspection of the above elechical work at: 1ob Address �Sheef, Box, or Route No.) Cify Zip Code �Y4R ��cp��n ��,rv � ��IQ.�I �Slf3 7-- or No. Occupanf ` Phone No. a63 -��7� Power Supplier Address , ,�� P s G��-Y� �� s<o� Electricai hacfor �ompany Name) Conhacror license No. Master Lic. No. (Planf Elecf. Or C6tJ/j ��/' Mailin�dress (Conkacfor or Owner Performing InslallaKon� �' Y A ori naNre ( ho or r ner Performing Insfallafi Phone No. � �6' ��ZS�{ -(077 1A-11 8/96 S7p� BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY