P - 81468REf�UEST FOR ELECTRICAL INSPECTION
7n Minnesota State Board of Electricity
�# �-� 11 't m 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �`
Phone (612) 642-0800 ^� � �
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Home Duplex Apt. Bldg. Other: New Addn
Commercial Industriol Farm Remod Re air
ir ond. , t. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above fhe work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculafe Inspection Fee - This Inspection Request will not be accepted wi►hout the correct fee:
Other Fee # ice Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 t 0 Amps 0 to 100 Amps
Street Ltg./Troffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Oudine Ltg. Xfmr. j �� �� . SC�
Alarm/Remote Control �� ^
$wimming Pool � �/�_ �
I hereb certi that I ins ected fhe electrical insfallation described herein on t e datel s ted
Irrigation Boom Rough-In �
Special Inspec
Final ��
Investigative Fee Q
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MON HS.
OFFlCE USE ONLY This request void 1 B monfhs from validation dafe prinfed in }his box.
I�IIIIIIIIIIIIIIIIIINII��,���II�I��I� �' �75.�
* 0 7 4 8 6 1 1 1* `��
PLEASE PRINT OR TYPE
Requesf ate Rough-in inspeclion required? es ❑ No Inspection Ofher Than RougfFln: ❑ Ready Now ill Call
/� lq (`(ou musf call the inspxtor when ready� Date Ready:
I, icensed contractor ❑ owner hereby request inspection of the above electrical work at:
�°b Sd�`t�'b�s����` R��ET �'R I DLEY, MN ZiP Code
Section No. Township Name or No. Range No. fire No. County ^ �
i=n'� Lu
�"�THY/GUY JQRDAN Phone No.
Power Supplier Address
S f�
Electrical Conhacfor �Company Name� Confractor License No. Master Lic. No. �Planf Elett. Only)
M I F�.—LYIV ELECT R I C CQ. CA� 1�46
Mailing Address (Conhacfor or Owner Performing Insfallation�
1�.:,58 Husiness F�ar•k Hlvd, CHAMF�LIRI, MN 55�1E
Authorized S' re �Conhactor or Owner P rming Insfallation . ��� C� �� Phone o.
E 1 1 /96 S7ATE BOARD COPY - SEE INS7RUCT10NS ON escK oF veuow r_nav