P - 83152REQUEST FOR ELECTRICAL INSPECTION :��
6 ������ � 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 >- Addn
Commercial Industrial Farm Remod Re air
Air Cor� Htg. Equip. Water Fitr. 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 Inspection Fee - This Inspection Request will noi be accepted withoui the correct fee:
Other F,ee # 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 u� qle��� �� TO,T�A.�L ,p� ��
Sign/Outline Ltg. Xfmr. b l5�� l`��"
Alarm/Remote Control
Swimming Pool
1 hereb certi thaf I ins the elechical installation described herein on the dates stafed
Irrigafion Boom RougMn Dare
Special Inspection
Firial D 2 �
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MO�iTHS.
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OFFICE USE ONLY This request void 1 S months From validation date prinTed i� IFiis box.
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PLEASE PRINT OR TYPE
Raquest Dare Rouglrin inspecfion required? ❑ Yes No Inspecfion Other Than Rough-In: Ready Now � Will Call .
�.� �� �You must call the inspecfor when ready� Date Ready .��� �
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Route No.� � City Zip Code
Si�BZ -,� BrEr��t �i- fRSS f�'�c�le
Seclion No. Township Name or No. Range No. Fire No. County
Occupant Phone No.
�ar-� / ���sah J�"7!- 8S9 d
Power Supplier Address
Elechical Conhacfor (Company Name) Conhacfor License No. Master Lic. No. (PlanY Elect. Only�
�Ts'F�cr�e�c efto�s�89
Mailing Address (Contracior a Owner Performing Insiallation)
87�0 �5"�� veN� ?�iy,�,• . SS348'
� Aufhorized $ignafure �Confractor or Ow erForming Insfallation� Phone No.
y�-9az.a
E 001 A-11 8/96 ` ST BO D COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY