P - 80143�C�2-351 �
Home Duplex
Commercial Industri
Air Cond. Htg. Ec
Dryer Range
"X" above the work covered
RE(�UEST FOR ELECTRICAL INSPECTION :
Minnesota Siate Board of Electricity � q s
1821 University Ave., Rm. 5-128, St. Paul, MN 55104 =
Phone (612) 642-0800 '�� �
Apt. Bldg. Other. New Addn
�I Farm ,� �� ,>%A� ,,SO Remod Re air
uip. Water Htr. Load Mgm . Other:
Efec. Heat Temp. Service
by ►his request. Enier remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted wifhout the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
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 TOT L
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Control � $'� �"�
Swimming Pool
I hereb certi fhat I ins the electrical installation dexribed herein on the dates stated
Irrigation Boom RougMn Dare
Special Inspection
Investigative Fee F�n�' �� ^— 2.�G
THIS INSTALLATION MAY BE ORDERED DISCONNECTED fF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void months from volidafion date printed in this box.
II��IIIIII�II��II�IIII���III��IA��I� /a 5o7S
� 0 8 0 2 3 5 1?* �* 86.60
PLEASE PRINT OR TYPE
Request Date Rough-in inspecfion required$ ❑ Yes � No Inspection Ofher Than Rough-In: ❑ Ready Now�Will Call
/� � Oa �You musf call the inspector when reody) Dafe Reody:
licensed conkactor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sfreet, Box, « Rouse No.) City Zip e
�/�9 ` 'ao�s f%e�i.� — .�al r �� 02/
Secfion No. Township Name or � Range No. Fire No. County
� �?
Occupant � Phone No.
+Ja�.v ri�'��iv1 e ? G3-.�7,�-gD3
Power Suppl' � �� � Add s
(.�S c5 �-/ l (}•
EI icol Conhacbr �Compony Name) Conhacfor License No. Master Lic. No. (Plant Elecl. Only)
�°/� �/�� ,� .�_NC_ � O �y .�
Mailing Address (Conhacfor or Owner Performirg InsfallaKon)
S� � �
AWhoriz nafur onhactor or Owner P rm' I Ilafion� Phone No. 7G3
�� �
E -1 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY