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P - 79882REQUEST FOR ELECTRICAL {NSPECTION � Q O�����% � Minnesota State Board of Electricity v � 1821 University Ave., Rm. S-128, St. Pauf, MN 55104 � Phone (612) 642-0800 Home Duplex Apt. Bldg. Other: New Addn Commercial {ndustrial Farm Remod Re air Air Cond. Hfg. Equip. Water Htr. 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 white copy only. �� � r� p �eY v � �� � �E �� s �.iz.� �c� Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee: Other Fee # e' ance Si e Fee # Circuits/Feeders Fee Mobile Home Park Stall t 200 ps 0 to 100 Amps Street Ltg./Traffic Sig. Abov�-2@0 l�m s Above 100 Amps Transformer/Generator INSPECTOWS USE ONLY TO � Sign/Outline Ltg. Xfmr. A� Q•] � < Alarm/Remote Control �< <� �> > S, Swimming Pool ��' / � G I hereb certi ihW I ins � the electriwl installafion described he n e slated Irrigation Boom RougMn • � Special Inspection ��"� Investigative Fee F���� �j d %� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WRHfN 18 MONTHS. , OFFICE USE ONLY This request void 18 monihs irom validation date printed in this box. I 1��1 II I�) II III (I III II II� II III I� III II III II III I IIII n � � * 0 8 0 2 3 3 7 6* 2 9�� 1(��� PLEASE PRINT OR TYPE �`� Requesf Date Rou h-in ins on r uiredR ❑ Yes g pecfi eq ❑ No Inspection Other Than Rough-In: ❑ Ready Now � Will Call . �`/ou musl call IFie inspector when ready) Date Ready: I, ❑ licensed contractor ❑ owner hereby request inspection of the above electrical work at: Job Address (Street, Box, or Rovte No.) Ciy Zip Code l 4s l�-�Tn�n-�� � L- ss4�3 z Seclion No. Township Name or No. Range No. Fire No. Cou�ty Occupanf � �� � Phone No. �iou�(s"i?� '�63-so2- 30�0 Power Supplier Address �1CCP�L Electrirnl Conhacbr (Company Name) Coniracror License No. /vlaster Lic. No. �Plant Ekct. Onl� Mailing Address (Conhacfor or Owner Pedorming Insfollalion) � / I.s�.11��� I STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY