Loading...
P - 84259��Z6-989 w¢ � X Home- Du Commercial Inc Air Cond. Htc Dryer Ra "X" above the work cov REQUEST FOR ELECTRICAL INSPECTION Minnesota State Board of Electricity 1821 University Ave., Rm. S-128, St. Paul, MN 55104 Phone(612)642-0800 Farm Water Htr. Load Mgmt. Other: Elec. Heat Temp. Service �,� �l�y) request. Enter remarks in this space and on the back of the New Remod ,;�. :,� � '.�` n -11� :� copy only. Calculate Inspection Fee - This Inspeciion Request will not be accepted without 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 Amps Above 100 Amps Transformer/Generator INSPECTOR'S USE ONLY TOTA'L Sign/Outline Ltg. Xfmr. � J f�� Alarm/Remote Control Swimming Pool I hereb certi fhat I ins cted fhe elechical installation described herein on the dafes sfafed Irrigation Boor{'] A!1 .�^a Rouah-In Dare Investigative Fee ' �►� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONT S. OFFICE USE ONLY This request void 18 months from validation date printed in this box. � ���� �� ��� �� ��� �� II� �i ��I11�1� �I� �� ��I �� u� � � � III --a * 0 4 2 6 9 8 9 0 * ���`� �`� PLEASE PRINT OR TYPE Requesf Date Rough-in inspection required? ❑ Yes No Inspecfion Ofher Than RougMn: ❑ Ready Now Will Call I� j� ��% (You must call the inspector when ready� Date Ready: ,�,� � I, 1� licensed contractor ❑ owner hereby request inspection of the above electrical work at: Job Address �Street, Box, or Route No.) City Zip Code `�ciS � S�-I- I� �, �--aq � � e SS�13� Secfion No. Township Name o. Range No. Fire No. Coun � j occopoor Power �oNx1��� ���,�e�,� N� � Address /�-t �p �Cff Phone No. �7�C� �'C� -actor (Company Name� Contractor License No. Master Lic. No. (Plan ���✓ F1 �-��ic ���. C1��..3�Z� ss �Conhactor or Ow er Performing Installation) �- �s� � D� �' A �cl �v � l'�'��% ���0� no �(Conhacror or Owner PerForming Insfallafion� ��('� �� Phone No. � � } � �-� r d fa/ � �� �!� 8�96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY