P - 83760REQUEST FOR ELECTRICAL INSPECTION I
C��° ,�,, %� O� � Minnesota State Board of Electricity
`°'d `�. �'� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
�
Phone (612) 642-0800 '��
� Home Duplex Apt. Bldg. Other: New Addn
Commercial Indusfrial Farm Remod Re air
Air Cond. Htg. 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.Z.. Poci ��:ve�, 3- �'e,� i� sX� Fu.r��_ 1/an �,�
Calculate Inspection Fee - This Inspection Request will no► be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY T TA' �;
Sign/Outline Ltg. Xfmr. �
�t
Aiarm/Remote Confrol ?3
Swimming Pool
. I hereb cerfi that I ins ted the electrical installation described herein on ihe dates stated
Irri9ation Boom �_. Rouqf.ln �. �� Dare
Fee
!
Irnestigative Fee �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This requesf void 18 months from validafion dafe printed in fhis box.
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* � 5 0 9 9 � 3�e * PLEASE PRINT OR TYPE
Requesf Date Rough-in inspection required? ❑ Yes
❑ No Inspeclion Other Than Rough�n: ❑ Ready Now
�, �/�� �You must call }he inspector when ready) Dafe Ready: .
I, ,�licensed contractor ❑ owner hereby request inspection oF the above electrical work at:
lob Address (Sheet, Box, or Route No.� City Zip Code
� c;.l� � �" � s'�+ i�, �s° =
Seclion No. Township Name or N. Ranpe No. Fire No. ounN .
'� �� �
Occu nt 1 /�
� i�.�ij �i � 3�t1 /�/ � `-'V 9 I �" 6 / I �/' � Phon l � � ~!
Power Suoolier _ Add.>«
:onhactor (Company Name�
%r.�� L���t���
Idress � ntractor or Owner Perfom
�C� 'hs�.�� �
STATE
Conhactor License No.
1+,��. G�o�io�!
Insfallatio
? Gc� ���
iin Installafion)
25��3�'
i OPY - SEE INSTRUCTIONS ON BACK OF YE
Masfer Lic. No. (Plant
ione No.
7��-a�
Call