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