P - 84732REGIUEST FOR ELECTRICAL INSPECTION —
4 Q C� - 5 3 0 Minnesota State Board of Electricity
, 1821 University Ave., Rm. S-128, St. Paul, MN 55104
. Phone(612)642-0800
Home Duplex Apf. Bldg. Other: . New Addn
ommercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request Enter remorks in this s ace and on the back of the wh'te copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance "ze Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 Amps 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generafor INSPECTOR'S uSE oN�Y �ln TOT ���
Sign/Outline Ltg. Xfmr. � 1
Alarm/Remote Conhol � �,� SV�
Swimming Pool
1 hereb certi that I ins ted ihe elechical installafion dexribed herein on fhe dates stated
Irriaafion Boom o,...,.�.�.. �_._
� Imestigative F6d �'� �7 f 7 L— < �"�L-"_: I��.� ^` 7` L
THIS INSTALWTION MAY BE ORDERED DISC NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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* 0 4 4 8 5 3 0 6* PLEASE PRINT OR TYPE '�� ���
quesf Dafe Rough-in inspection required? ❑ Yes o Inspection Olher Than RougM eady Now ❑ Will Call
�You must call the inspecror when ready) Date Ready: �
icensed conhactor ❑ owner hereby request inspection of the above elecfrical work at:
i Addre (Sheet, Box, o�ufe No.� ��� City� � Zip Code
� �' n� �•� 1
:tion No. Township Name or No. Range No. Fire No. Coun /� �,
Power
or
f `��L��it�
r�o�e No.
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No.
�� 252 �? � I � �� L� - �s�
11 8/96 �pTE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY