P - 80715REGIUEST FOR ELECTRICAL INSPECTION
1 f I� 7 2 6� Minnesota State Board of Electriciry
_ 1821 Universiry Ave., Rm. S-128, St. Paul, MN 55104 =
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Form 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 fhe back of the white copy only.
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Calculate Inspection fee - This lnspection Requesi will noi be accepfed without ihe correcJ fee: ZQ p
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps ��i :- � 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR�S USE oN�v TOTAL
Sign/Outline Ltg. Xfmr. 2�
Alarm/Remote Conhol
Swimming Pool
I hereb certi that 1 ins ecfed the eiectrirnl installafion described herein on the dates stated
Irrigation Boom Ro„Qha„ pate
Investigative fee - � �"" � ' �*se.<g �y�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY Tfiis request void 18 monihs from vaiidation date printed in this box.
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PLEASE PRINT OR TYPE
Requesf Dafe Rou h-in ins Kon r uired? Yes
��_�^ g pec eq ❑ No Inspection Other Than Roughan: Ready Now ❑�II Call
5�— 7 �You must call the inspector when ready) Date Ready: 2� �
I, Ily.licensed confractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sheef, Box, or Roufe No.) Cily Zip Code
0 9 uG� E fcv�E. . N E. � R�vL�Y 55�21
Section No. Township Name or No. Range No. Fire No. Coun "
— - - ---- - �C►�N r'P►V�1
Occupant Phone No. ��
RoN N�w 1 ii 6 Iz— 5'�Z— B
Power Suoolier Address
al Confractor �Company Name� Conkacror License No. Master Lic. No. (Plant Elecf. OnF
� t�o� E5 '��_ �t�� � C.� �3o b 5
� Address �Conhacror w Owner PerForming Insfollation) � �
8819 oR�Go� �►�. N 6�o�.V�N P/r��C� MN 55'��5
ized Si naNre (Conhacror or Owner Performing Installafi n) (` y „� Phone No.
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)1A-11 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY