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P - 82425(�����-309 � REQUEST FOR ELECTRICAL INSPECTION = Minnesota State Board of Electricity 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 (651) 642-0800 www.electricity.state.mn.us Home Duplex Apt. Bldg. Other: New Addn Commercial Industrial Farm Remod Repair Air Condifioner Hig. Equip. Water Hfr. Load Mgmt. Other: Dryer Range Elec. Heat Temp. Service "X" above the work covered by this requesi. Enter remarks in this space and on the back of the white copy only. ��V� C� C���.�-- � �/ �--- Calculate Inspection Fee - This Inspection Requesi will not be accepfed wiihout the correct fee: Other Installafions Fce # Service Enh nce Siz Fee # Circuits / Feeders fee Mobile Home Park Stall 0 0 200 mps ` 0 to 100 Amps Street Ltg. J Traffic Sig. Above 200 Amps Above 100 Amps Transformer/Generator INSPECTOR'S USE ONLY TOTA ;_]'1 Sign / Outline Ltg. Xfmr. � VV Alarm/Remote Control Swimming Pool I hereb certi that I ins ed rhe elechical installation described herein on the dates stated: Irri ation Bo �' ^ 9 Rough-In Dafe Speciallnspection � Final Dat r q j ,�� Investigative Fee �-� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. OFFICE USE ON4Y This request void 18 months from validafion date printed in lhis box, I��I��I��I�I���II�I��II�II��i�IN������ � * 0 9 8 6 3 0 9 3* ��� �~µ' lp i�`g PLEASE PRINT OR TYPE R f D � Rough-in inspecfion raquired$ ❑ Yes ❑ No Inspecfion Ofher Than RougMn: ❑ Ready Now ill Call � You must call the inspector when ready Date Ready: 1,�1icensed contractor ❑ compony ❑ owner hereby request inspection of the above electrical work at: Jo Ad ress eet, Bo , r Route o.) Zip Code r,' e Section N. Township ame or No. ange No. Fire No. Coun Occupant Phone No. 10981 4TH ST. NE Address (Contractor, Com any or Owner Perfor IANOVER MI� 55341 � BOARD COPY Master Lic. No. I Vf�i'�-JO'%d-rlJ I SEE INSTRUCTIONS ON BACK OF YELLOW COPY