P - 79902, REGIUEST FOR ELECTRICAL INSPECTION
8 0�� J� 1 � Minnesota State Board of Electricity
.�.. 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0 0
Home Duplex Apt. Bldg. Other: ,� New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Hfr. Load Mgmt. 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 whiie copy only.
(adar �-ro�. e.�.cl� �t-�.oc1�( yc� �c��� e�.._�t d;�i� g
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
Street Lt ./Traf�ic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TO AL
Sign/Oudine ltg. Xfmr. �y�' � O
AlarmjRemote Control
Swimming Poo 1 - � �-�
I hereb certi that I ins the el ical insfalla6on described herein on the les stated
_ Irrigption Boo ` RougMn Dare
Special Inspection (4, r. Q,L_ o'�,
F;�� D a c �
Investigative Fee '�
TH1S fNSTALLATION MAY BE ORDERED DISCON TED IF NOT COMPLETED WITHIN 18 MONTHS.
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OFFICE USE ONLY This requesf void 1 S months kom validafion date prinfed in this box.
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PLEASE PRINT OR TYPE
Re9�g� �^� r ��� Roogh�in inspection required? �Yes ❑ No Inspection Ofher Than Rough-In: ❑ Ready Now � Wil) Call
` (You musf call the inspector when ready� Date Reody:
1, ❑ licensed contractor �owner hereby request inspection of the above electrical work at:
Job Address (Skeet, Box, or Route No.) City Zip Code
�,s�g F.�.�_��. �,� �i� �r�d���, SSy3Z-
Seclion No. Township Name or No. Range No. Fire No. County
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Occupanf Phone No � � b � , � �
c��r �.su� `7�3 ^ �
Power Suppli r 1 Address
��2 l D l c /t r�,� �`�-! �> i/
o�
or cmner rertorm�� �mtoii t l!�� � I//n� �L 1�.
STATE BOARO COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY