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P - 82537_ RE(�UEST FOR ELECTRICAL INSPECTION ���°'E � /�1� Minnesota State Board of Electricity 3 ��� 4��`� �� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 (651) 642-0800 www.electricity.state.mn.us `�=�' of the white copy only. ����V Calculate Inspec�ion Fee - This Inspection Request will not be accepted without the correct fee: Other Installations Fee # Servic t ce Size Fee # Circuits / Feeders Fee Mobile Home Park Stall t 200 mps 0 to 100 Amps Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps Transformer/Generator INSPECTOR'S USE ONLY TOTAL �"'� Sign / Outline Ltg. Xfmr. � ��� Alarm/Remote Control � Swimming Pool I hereb cerii that I ins ected the elecfrical ins allation described herein on the dates stated: Irrigation Boom ' so�9h-I� - � �O} l�y� Special Inspection pa Final Investigative Fee THIS INSTALLATION MAY BE ORDERED DIS CTED IF NOT COMPLETED WITHIN 18 MONTHS. OFFICE USE ONLY This requesf void 18 months from validation dafe prinied in ihis box. IIIIIIIiiiIIIIIIIIIiIIIIIIIIIIII�IMi�llllllllllll ���� �K 0 9 4 1 4 6 3 c� �4 ���:1�� PLEASE PRINT OR TYPE Request Dafe Rough-in inspection required? �❑ No Inspeciion Other Than Rough-In: ❑ Ready i Call �—�� �� � You musf call fhe inspector when rea y Date Ready: I�censed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: )ob Address �Street, Box, or R ute No.� City f Zip Code 1P ?5 � 2 -p �Y'i r^ ('pl 'e' � t � Secfion No. Township ame or No. Range No. fire No. Coun o«oponr S j''e. �i Power Supplier A) S1 �,al Contrac or / Com an Na I� � t, P Y��"� A ` 3 Address (Contractor, Company o�r. pO.�w� � � � � ize i n re(Confr ctor, C pany or 91A-12 5/1999 STATE� � �var n �� � formi g nsfallation� t./ `�_ r Per ing Installation) COPY �I �24' ��1 ,�� � Zl-10 0�� � 1 �' L � � No. �Plant Elect. G� 8'1 SEE INSTRUCTIONS ON BACK OF YELLOW COPY