P - 79837RE(�UEST FOR ELECTRICAL INSPECTION
8 0�- 3 4 6 0 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 Cond. Htg. Equip. Water Htr. Load Mgmf. 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.
Calculafe Inspection Fee - This Inspection Request will nof be accepted without fhe correct fee:
Other Fee # Service Entrance ' Fee # Circuits/Feeders Fee
Mobile Home Park Stall to 200 Amps d 0 io 100 Amps
Street Ltg. Above 200 Amps Above 100 Amps
Transforme INSPECTOR'S USE ONLY TOTA� (
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins elechical installation described herein on the dales staled
Irrigation Boom RougMn
Speciallnspection � � � a
final Dafe d
Investigative fee '�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request wid 18 months from validation dafe printed in this box.
I I�II II III II III II III
IIIIIIIIIIII���II�I� p ,�3
* � 8 0 2 3 4 6?� 1�� � �/��
PLEASE PRINT OR TYPE
Requesf Dafe Rough-in inspection required? �Yes ❑ No Inspecfion O�er Than RougMn: ❑ Ready Now 0 Will Call
b�You musf call the inspecfor when ready) Date Ready:
I, [� lic nsed conhactor ❑ owner hereby request inspection of the above elechical work at:
Job Address) Sheef, Box, or Roufe No.� Ci Zip Code
� G �,¢r'n.c�a,�� �r�d� `_�3�
Section No. Township Name or No. ''. `�-� Range No. Fire No. ny
�a 296�' z�- �
Occupant t Ph ne No.
��e.�-e� �So� �/2 l 3o Z
Power Supplier Address
� kc� c— � . vv��..
Eleclrical Conkactor (Company Name) Conhador License No. Master Lic. No. �Planf Elect. Only)
�` ✓ "r' \�QC � ��
Mailing Address (Conhac�or w Owner Performing Installation)
L�k L,A.�.� � UV. t(z`�Si�L S`5 �
AWhorized SignaNre (Conhac�or or Owner Performing sfallation� ��e Na•
O�� [G� .r �I � / �5 � ��� �
EB-OOOOlA-11 8/96 �p� gppRD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY