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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