P - 81333i REQUEST FOR ELECTRICAL INSPECTION �''`'��,
7�i Q Minnesota State Board of EfectriciTy � �'
i 1 O-� 4 3� 1827 University Ave., Rm. 5-128, SL Paul, MN 55104 ���
Phone (612) 642-0800 .
Home Dublex Apt Bldq. Other: New Addn
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�� Hlg. Equip. Water Hh. Load Mgmf. Olher:
Ronge Elec. Heot Temp. Senice
e work covered by this request Enter remarks in this space and on fhe back of t)
.�n� �/c �- �
pecfion Fee - This Inspeciion Requesf will n occepled withouf the mrrect fee'
Other Fee .# Service Entrance Size Fee # Circuit
ome Park Stall 0 to 200 Amps 0 to 700 P
./Traffic Sig. Above 200_Am s Above l OC
ier/Generaror INSPECTOR'S USE ONLV
'Iine Ltq. Xfmr.
copy
Fee
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Swimming Pool I here6 cere ihat I ins ened rhe elecrricol mstallmion descr�b d herein on ihe daies sm�ed
Irrigation Boom po„9�,i„ � oa�e
Speciallnspecli
ftlrmF— � D �.
Imestigptive Fee � j
_THIS INSTALLATION MAY BE OADERED UISCONNECTED IF NOT COMPLETED WITNIN 18 MONTHS.
I� IIIII �IIII IIIII IIIII II� IIIII IIIII �II OFFICE USE ONLY This requen void 18 monllis� validalian��n �s box.
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PLEASE PRINT OR TYPE
Requesr Daie � kough�in Inspection requtredB ❑ Yes ❑ No lospecnon Olher Thw Raugh In: Ready Now � WIII Call
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�Y'ou pec�arwhen �eady� Dok Reody:
'cenaed contractor � owner hereby request inspection of the above elecirical work at:
b Address �Skee�B�,x, ar Rook No.� ^ . ^/ Ciy'� ' n Zip Code /
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2619 Coon Ra�ids Blvd. NW
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