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Home Duplex
Commercial Industrial
REGIUEST FOR ELECTRICAL INSPECTION �,����
Minnesota State Board of Electricity � 3;
1 8 2 1 University Ave., Rm. S-128, St. Paul, MN 55104 �, ��
Phone (612) 642-0800 ��`'���:'�
Other: New Addn
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.
�'EP�iIcE S�'ve�c l�1�r/c� /�?ov�'.
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Calculate Inspection Fee - This Inspection Request wil not be accepte without the correct fee:
Olher Fee # $ervice Enhance $ize Fee # Circviis/Feeders Fee
Mobile Home Park $tall � 0 to 00 Amps /S� � 0 (a 0 to 100 Amps � d
Street Ltg./Traffic $ig. Abo e 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'SUSEONLY TOT Sd
Sign/Outline Lig. Xfmr. ` � ���
Alarm/Remote Control
$wimming Pool ��
I hereb ceAi ihat I i ed }he eledncal installation described her ' the dates sfated
Irrigation Boom Roogh-In 4C D
Special Inspe �.�, pat� �!
Final
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
315 - 6 6 3� OFFICE USE ONLY This request void 18 monihs from validation date prinfed in ihis box.
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PLEASE PRINT OR TYPE
Request Date � Rough-in inspedion required2 �Yes � No Inspection Ofher Than Rough-In
�� J� 9 (You must call the inspedor when reody) Date Reody:
I� licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sfreet, Box, or Rouie No.) City
.� I .��c,�ti �5�: ,�o- � . �,��dLE
Section No. Township Name or No. Range No. Fire No. County �
iyt Sr��rr�t E�
Power Supplier
Address
Phone No.
�d,NS�- �7� �
rReady Now � Will Call
Zip Code
V��
Eleciricol Coniracior (Company Name) Conirador License No. Master Lic. No. (Planf
METTLER ELECTRI CAO 1223AM0 2589
Mailing Address (Confrador or Owner Perfortning Installation)
1240 46th Ave. N.E., Mpls., MN 55421
Aufharized Signofure (Conirador or Owner P •I Ilati A p�/ Phone No.
Mi el L `� o I �
EB-OOOOlA-10 6/95 STATEBOARDCOPY-SEEINSTRUCTIONSONBACKOFYELLOWCOPY