P - 81456REQUEST FOR ELECTRICAL INSPECTION
6� U= 2 7 4 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Hfg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above ihe work covered by this request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps ' S. C�%
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps �,
Transformer/Generator INSPECTOR'S USE ONLY TOTAL �—+ �
Sign/Outline Ltg. Xfmr. � J • �
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins fed the elecfrical insfallation described herein on the dafes sFafed
Irrigation Boom RougMn Date
Special Inspec �� , _ 1' —
Final
Investigative F . ) �t � �� i
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Dafe Rou h-in ins ection r uired? Yes
g p eq � ❑ No Inspecfion Other Than RougMn: ❑ Ready Now �Will Call
�— ��� (You must call fhe inspecfor when ready� Dafe Ready:
I, �( licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Roufe .) City Zip Code
C/ �L � C/ . � /
Secfion No. Township Name or No. � Range No. F e No. C � A
uccupa �; / Phone No.
7r ` �p /
Power Supplier Address
N.S,Pe 3115 CEN^1ER POINT DR
Elecfrical Contracfor �Company Name� Conhador License No. Master Lic. No. (Planf Elecl. Only
Marshall Electric Inc. CA01184 AM02474
Mailing Address Conhactor or Owner Performing Installafion)
9 0 J a�a Ave . N. Mah medi -,��j, � � 5
Aufhoriz Si afure (C hactor ner Installation) Phone No.
c
' � 426-3370
EB-00001 A-11 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOw Coav