P - 83172,l��i�rIII��I�IIIIIIIIII��II�IIIIIIIIIIIII�I�llllll� R82�1 UEiSersFORve.LRm. SRIC8 St PaPEMNION04 ����
Minnesota State Board ot Electncity �
* 0 3 7 6 5 6 3 3�` Phone (612) 642-0800 �����
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air C Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat emp. Service
X" above the work covered by ihis requesi. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted wiihout 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 TOTAL
Sign/Outline Ltg. Xfmr. $
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Speciallnspec `
Final Dat%, Z� ^��
Investigative Fee �
� _ THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
37^_�� ` OFFICE USE ONLY This reques[ void 1g months from validation date printed in this box.
lJ �2
t�
� /5 57J
a 3aa
PLEASE PRINT OR TYPE
Request Date �
�4� Raugh-in inspection required? ❑ Yes �No Inspection Other Than Rough-In: pX�dy Now ❑ Will Call
(You must call [he inspector when ready) Date Ready:
�, [�licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.)
City
Zip Code
Section No. Township Name or No.
Range No. Fire No. County
���
Occupani
DOUG CLOUIER � Phone No. ,'`� ,�
��wH,w
Po N���
Address
Electrical Contractor (Company Name)
EK ELECTRIC INC Contractor License No. Master Lic. No. (Plan! Elect. pny)
CAUQ558
Mailing Address (Cpntractor or Owner Performing Installafion)
15714 DAKpTA ST NW pN�p�R � 55304
Authorized ignature (Contractor or Owne e ming Installation) �
� M1 y� Phone No.
� 6 Q V � d21-5067
EB-���A-� �$�95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY