P - 83133REQUEST FOR ELECTRICAL INSPECTION _
6 O�3 �� 319 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 -
, Phone(612) 642-0800 "�'
Home Duplex Apt. Bldg. Other: New ddn
Commercial Industrial Farm Remod Re air
ir Conc�j< Ht . Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspeciion Fee - This Inspection Request will not be accepted wifhout the correci fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTI�� a��
$ign/Oudine Ltg. Xfmr. �
Alarm/Remofe Conhol
Swimming Pool
I hereb certi thaf I ins the eleclrical installafion described herein on the da�es stated
Irrigation Boom Rouglrin Date
Speciallnsp (
Finel � �
Investigative Fee ,
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF �IOT COMPLETED WITHIN 18 M013THS.
ORRCE l�E ONLY This request void 18 months from valid d te printed in this x.
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PLEASE PRINT OR TYPE
Requesf Date� �� Rough-in inspecfion required? ❑ Yes Inspection Olher Than Rough-I ' ady Now ❑ Will Call
(You must call the inspecror when ready� Date Ready:
I,�licensed contractor ❑ owner hereby request inspection of the above elechical work at:
Job Address (Sheet, Box, or Ro No.) City ♦ Zip Code
!' a �' ro Yt � � �� �-� a
Secfion No. Township Name or No. Range No. Fire No. County !'" `/ [� �
Occupant Q � D�� . / Phone No. �
l �,j 57�-� 3�
Power $upplier Address
SPARK �L�CTRIC
Mailing Address (Conhacfor or Owner PerForming installation)
2114 wASHTNGTUN ST N.�.
Authorized Signafure (Conka_ ctor Qr r Performing In�
-.� vJ
E&00001 A-i 1 8/96 STATE BOARD COPY -�
Conhaclor License
CAU1700
� � � f y Phone No.
tir V � � �
ON BACK OF YELLOW COPY �