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P - 82660. 4�4-627 � Commercial Air Cond. Dryer "X" above the � Industrial Hta. Eaui REQUEST FOR ELECTRICAL INSPECTION Minnesota State Board of Electricity � `� 1821 Universiiy Ave., Rm. S-128, St. Paul, MN 55104 Phone (612) 642-0800 `���� Apt. Bldg. Other: New Addn Farm emod 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 accepted without the correct fee: Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Mobile Home Park Stall 0 to 200 Amps � % 0 to 100 Amps '7 S' a'd Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps Transformer/Generator INSPECTOR'S USE ONLY _, TOTAL� Sign/Outline Ltg. Xfmr. �F���:, � Ldwt� ��y'��" f ��7 s S� Alarm/Remote Control Swimming Pool I hereb certi fhat I ins fed the electrical installafion described hereA ' dates stafed Irrigation Boom Rough-In � A� _ 2� Dare C� Special Inspecti � — < Final /� " Date� � �^+. Investigative Fee � 't'�-- — y— THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. �_ _ _ — OFFICE USE ONLY This request void 1 8 monihs from validafion date printed in this box. I IIII II Ifi ii Ili II III ii III II II IIIIIillllll► �L�G � � � � * 0 4 0 4 6 2 7 2* PLEASE PRINT OR TYPE Requesi D� Rough-in inspecfion re uired? � QS 9 ❑ No Inspecfion Other Than Rough-In: ❑ Ready Now �� �i � ��- (You musf call fhe inspecfor when ready) Date Reod : Y I, �icensed contractor ❑ owner hereby request inspection oF the above electrical work at: Job Address (Sireet, Box, or Roufe tye7l � City Zip Code !� , � ' t: o� - y��'�r � � � � . I`, r �'e?� � ��`� �`� c,�, Sechon No. Township Name or No. �� Range No. Fire No. o` ��n, Occupant E' %% /�r�`r / �t — ��.; �� C 'f '�i I Power Supplier �� Address f ' _;` f-� Elechico Contracfor (Company� }Name) � l.�£ ]�-'�C{�/ ���1/'?��.�j'`}�/ Mailing ddress (ContracL or,(�wner Performing Insfallafion) _i� � a '� �l',/ ��1 ^ , �s � Authonz�d.$�pna�ure �Conhac}or or Cawtmn �,.,��.. i..��,.n..«:...,i ZS xc�a �,�=--�' � STATE BOAR6 I Phone No. , '� � � �{ � �' i r Conhacfor License No. Masfer Lic. No. (Planf Elecf. Oi �" �,Z 1 �3 :�!' � ,�._� L-� �y'.to' SSl/� - %� P�o No. 11 �'` � � .lc�.:�` r�, - SEE INSTRl1CT1nNR nu Rec�t nc vc� i nw rnov Call