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P - 844314��.5-185 i "X" above the work REGIUEST FOR E CTRICAL INSPECTION -�•�. Minnesota State B d of Electriciiy 1821 University A., Rm. S-128, St. Paul, MN 55104 Phone(612)64 0800 Apt. Bldg. Other: New Addn Farm Remod Re air Water Htr. Load Mgmt. pther: Elec. Heat Temp. Service request. Enter remarks in this space and on the back of the white copy only. R�C►���ar� ��7- �'�'.s Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee: Other Fee # Service Entrance Size Fee # Circuits/Feede Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps Street Ltg./Traffic $ig. Above 200 Amps Above 100 Transformer/Generator INSPECTOR'S USE ONLY TO Sign/Oudine Ltg. Xfmr. / Alarm/Remote Control Swimming Pool Fee . c�J � I hereb certi tnat I ins ted the elechical installafion described herein on the dates stated Irrigation Boom - aough-io Dare Special Inspecti N :�) Investigative Fee F���� �v�.. —�— 3 THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. OPFICE USE ONLY This request void 18 monlhs 6an validation dafe printed in this box. I IIII II III II III II Ili II III II III I ��� �� II II III I�I ,�%sv `��`9a,3 * 0 4 L 5 1 8 5$�k LEASE PRINT OR TYPE Requesf Da� Rough-in inspecfion required$ ❑ Yes No Inspecfion Olher Than RougMn: ❑ Ready Now Will Call (You musf call the inspector when ready� Dafe Ready: I, licensed confractor ❑ owner hereby request inspection of the above elecfrical work at: Job Address �Sheef, Box, or Route No.) City Zip Code 1� i r I--�'Ct,Y I� � Fr� d � 554� /- Section No. Township Name or No. Ranqe No. Fire No. Coun _ / Address u � � h� Ad ime A/ 8; ELECT. lt�i; fRAL AVE. N.E. e�! o allation� er PerForming Installati< . STA BOARD COPY - : Phone No. �v��- �� �— Conkacror License No. Master Lic. No. �%ant Elecf. ����'CQ 4 S2 �., Phone No. '75?�a� NS ON BACK OF YELLOW COPY