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P - 79448REQUEST FOW ELECTRICAL INSPECTION ��"' ��r.� �(� rj ���g 4� Minnesota State Board of Electricity "� U L 1821 University Ave"�., m. S-128, St. Paul, MN 55104 ��.� Phone (612) 642-O�v n �/� �'� !/ �ome vupiez r�Ni. oi�y. ..i„�'. / V.. S� .L�/ Commercial Indushial Farm Remoc Air Cond. Hlg. Equip. Water HM. Load Mgmt. O�her Dry Range Elx Heaf Temp. $ervice � above the work rovered by fhis �equest Enfer rema�ks in this space and on the back of fhe whrte mpy Calculale Inspection Fee - 7his Inspecfion Reques� will r�o� bee accepfed withou� the mrrect fee: Other Fee # Service Entrance Size Fee # Circuifs/Feeders Fee Mobile Home Park Smll 0 to 200 Amps 0 fo 100 Amps Slreet Lig./Traffic Sig. Above 200_Amps Above 100_Amps Transformer/Generoror MSPECTOF'S USE ONLV TOTAL�/ �T Sign/Oudine Ltg. Xfmr. �/�C�� �U,� �� Q� �� Alorm/Remote Conhol � � �� �� $Wimmirtg Pool I hereb cen� �har I �� cied the elecrciml Insmllm�o� descrbed herein o� the dmes smted Irrigolion Boom Roughl� s27 �a Special Inspecfion F, al oo � Investigafive Fee — �� U � THIS INSTALLATION MAY BE OflDEREO DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. ` OFFICE USE ONLY This requesf roid 18 mon�hs from vafidafion date prinfed in Ihls bax. I lul I� III II II I I�) II III � I I I I II I I II II I I� * 0 8 0 2 2 9 4 4 x ����,� �/. � O PLEASE PRINT OR TYPE Requex� Do�e Rougbin inspection required2 ❑ yes ❑ No Inspecfian Other 1}ian Rough�ln: ❑ Ready Now � Will Call ' 6 I �You mon call �he inspeclor when reody� Oale Ready: I, licensed contracYOr � owner hereby re��]i!¢�ay�of the dbove eledrical work at ma No. . � Rre No. �►� �_�T�7s� � � \^•.l�'ZiS�A�E�J�GlY4AGTi ���e�� No.