P - 84665REQUEST FOR ELECTRICAL INSPECTION
/� Ch�' � 4 9 2 Minnesota State Board of Electricity
`t 1821 University Ave., Rm. S-128, St. Paul, MN 55104
. Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Indusfrial Farm X Remod
Air Co�d. Htg. Equip. Water Hh. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" obove fhe work covered by this request. Enter remarks in this space and on the back of the white copy
P.O. 40817 - Wire 1- 80 gallon water heater
Calculate Inspecfion Fee - This Inspection Request will not be accepted without ihe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./7raffic Sig. Above 200 Am s Above 100 Am
Transformer/Generator INSPECTOR'S USE ONLY TOTA
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi ihaf I ins the eleclrical installafion dexribed herein on the daMs
Irriqation Boom Q�,,,,tia„ n,,,e
�.,.,,
:;�....
91:
Addn I
Fee
20.50
Investigative Fee `" '� �l - '" � LJ � J
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 months (rom validation date printed in this box.
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* � 4 8 3 4 9 2 5* PLEASE PRINT OR TYPE
Re[{uest Date Rough-in inspection raquired? ❑ Yes � No Inspeclion Other Than Rough-In: ❑ Ready Now [�Will Call
06/25/97 (You must call fhe inspecior when ready) Date Ready:
I, � licensed conhactor ❑ owner hereby request inspection of the above electrical work at:
lob Address �Sheet, Box, or Route No.) City Zip Code
150 Island Park Drive N.E. F'
Section No. Township Name or No. Range No. Fire No. County
Occupont
Apartment Bui
Power $upplier
Eleckical Conhacfor �Company Name)
City Vie�� Electric, Inc.
Mailing Address �Conhacfor or Owner Performing Insfalla�
1145 SnellinQ Ave��ne Nor
CA00384
[-1L10�
Phone No.
No.