P - 77732� REQI,'EST FOR ELECTRICAL INSPECTION
O o�- 3 6 7 Minnesota State Board of Electricity
, 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
Phone(612) 642-0800
Home Duplex Apt. Bldg. C}th� ��-�� New Addn
Commercial Industrial Farm �' v Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. $ervice
"X" above the work covered by this requesi. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepied without the correct fee:
Other # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Par t 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL �,
Sign/Outline Ltg. Xfmr. �'��"'�''
t-S��i'
Alarm/Remote Control S h�� g'� 1- �
Swimming Pool !�3 , �j z3-�`L
I hereb certi that I ins ted fhe elecfrical insfollation described herein on Ihe dafes stated
Irriqation Boom Ro��nhJn /"� iS Dam _ t
� d3
SD
� Investigative Fee � �- �-- Z/�-ay%F/�A �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHI ONTHS.
— --- - -- — - ___— -----=f -
OFR('E USE �YLY This request void�r8`months From validalion date printed in this box.
( NI� �� ��� �� ��� �� ��� �� ��� �� ��� �� ��� �� (�� �� ��� � ���� !� 5' 7��
* 0 8 0 2 3 6 7 3* � �-�d
Requesf Date RouglFin inspeclion required? ��Yes
/� � �� (You must call the inspecror when ready)
I, ❑ licensed contractor �owner here �s�ctic
Job Address (Sheet, Box, or Roufe No.) / � ��
r y d�lo � zo N c R � �.
SecKon No. Township Name or No. Range No.
PLEASE PRINT OR TYPE
❑ No Inspecfion Other Than Rough-In: ❑ Ready Now Will Cal1
Date Ready:
�n of the above electrical work at:
C�y
r���� � �
Fire No. Couny
N�i��4-
P��3-� ��-7�a
1�Q,2;-rl �, �/
License No. Masfer Lic. No. (Plan
�.�D �-l�l 6Q�' ��/�C �
Power Supplier Addres
��L l� �S
Electrical Conhaclor (Company Name) Cor
Mailing Address (Conkactor or Owner Performing Installation)
a�
Elecf. Only)
'hone No. � r �
7G3-S��" �
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY