P - 82800�
REQUEST FOR ELECTRICAL INSPECTION u��..
�"� ��, ��� 00 Minnesota State Board of Electric+ty
`� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
> Phone (612) 642-0800 `�'
Home Duplex Apf. Bldg. Other � � New dn
Commercial Industrial Farm —p%��'%� � nd Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt, Other;
Dryer Range Elec. Heat Temp. $ervice
"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 not be accepted wilhout the correct fee:
dther Fee # Service E e Fee # Circuits/Feed Fee
Mobile Home Park Stall 0 t 200 p 0 to 100 Am Q,
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL ,/ s'�^
Sign/Oudine Ltg. Xfmr.
�l O �
Alarm/Remote Control
Swimming Pool �^� ��
I here certi that I ins Ihe elechiwl installalion described herein on the s
Irrigation Boom Rou Mn
9 ,� �., .� _ �-
Special Insp
Investigative Fee � F� 6 �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE UiSE ONLY This roqueat wid 18 months from validotion date printed in this box.
��I�I��I������ll��l� l�l � • ��.�
I�lll ��I�I� p
* 0 5 3 2 5 1 3 9 � �`O��
PLEASE PRINT OR TYPE
Requesf ��� R h-in i on uired? Yes
oug nspecti req ❑ No Inspection Olher Than RougMn: ❑ Ready Now ill Call
" (You must wll the inspector when ready� Date Ready:
I, ❑ licensed conhactor owner hereby request inspection of the above elech�ical work at:
Job Address (Stree�, Box, or Roure No.� Ciy Zip Code
5'4/ � F� y ST, N', F, � 5S� 3Z
Section No. Township Name�4 Rang� Fire No. Couny /���
�/
Occupant Phone No.
/�� c �iQr� ��'L,�.�t/ 6!Z 1�'6--6sq�
Power Supplier Address ^ c,I���O'L.ri�� * ♦
N S �' �`�`''°'�
Electrical Conha (C ny Name) ConhacTOr License No. Masfer lic. No. (Planf Elec1. Only)
�� ���
Mailing Addreu (Con o or er Performing Insfallafion) . �
C _
Authorized ' a�we �Conhactor w Owner smlla' � Phone No.
7�6 63
E 1 11 8/96 STATE D - SEE INSTpUCiIONS ON BACK OF YELLOW COPY