Loading...
P - 829221 6a�-788 � RE(�UEST FOR ELECTRICAL INSPECTION Minnesota State Board of Electricity ^ — 1821 University Ave., Rm. S-128, St. Paul, MN 55104 Phone (612) 642-0800 '�' Home Duplex Apt. Bldg. Other: New Ac Commercial Industrial Farm Remod e 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 the back of the white copy only. ,��sT@l/ �Ve� ���C� �'ocl�r.��a �� �a�e pr.r�n�/c's l�ah�e� iQ� .�e�ir° Cqlculate Inspection Fee - This Inspection Request will noP be accepted without ihe correct fee: Other Fee # Service Eotran ize Fee # Circuits/Feeders Fee Mobile Home Park Stall 0 to 00 Amps / � 0 0 to 100 Amps Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps Transformer/Generator INSPECTOR'S USE ONLY T AL[� C�.,.,/Cl��+lioolr., XF�,� �Ji�O Alarm/Remote Control Swimming Pool I hereb certi fhat I ins the elechical installafion described herein on the dates sroted Irriqation Boom R���{.io Dafe Investigative fe � Final /�"� +�������I �arer�� q.� ` CO ^�O THIS II�STALLATION MAY E ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. OFFICE USE ONLY This request void 18 months from validafion date prinfed in this box. ����I�II�I����l��ill�l�lll�i�������������ll� i �� .� * 0 6 4 2 7 8 8 4* 3��� PLEASE PRINT OR TYPE Request Date Rough-in inspection required? ❑ Yes o Inspection Other Than RouBh-In: eady Now ❑ Will Call �-- �Z ��� �You must call the inspedor when ready) Date Ready �� .r`� I, icensed contractor ❑ owner hereby request inspection of the above electrical work at: Job Address �Sfreef, Box, or Roufe No.) Ci / Zip Code a ST,�e�T �d e Section No. Township me or Nor � Range No. Fire No. � ounfy _ ������ C>e� =S ?"/�a H � Power Supplier � Elechjcal Co actor (Company Name� s��e l;�ec Mailing Address (Con acror or Owner PerFc �'�o� Ce�T/�I�l � Authorize1l $j8nafure (Conhacfor or pwner . � o�'R :� �'- Y�'i3 c �Q<G �G G�adi Z �g Insmllation � � se �✓, �� Sk�Tr%� S,o.�� , �A� STATE BOARD COPY ; b� 6� - � ON BACK OF YELLOW COPY u�. No. �°�rks"sy3. No. � --SozS-