P - 8278065�=534 �
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
. Other: New
Commercial Industrial Farm Remod
Air C Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by ihis request. Enter remarks in this space and on the
copy
Calculate Inspection Fee - This Inspection Requesf will not be accepted without the correcf fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amp:
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I he certi that I ins the elechical insfallation dexribed herein on the dates sT�
Irriqation Boom eM,,,�.. n,,,,
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Fee
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Invesfigative Fe�+ v 7Gi —/— o
THIS INSTALLATION MAY BE ORDERED DISC TED IF NOT COMPLETED WITHIN 18 MONTHS.
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-- OFFICE USE ONLY This requast void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Requesf Date Rough-in inspeclion required? ❑ Yes ' No Inspecfion Ofher Than RoughJn: Ready Now ❑ Will Call
"'T� ',,'���� (You must call the inspec�or when ready) Date Ready: '7 1 �/
l, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sheef, Box, or Roufe No.� Cily . Zip Code
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Section No. Township Name or No. Range No. Fire No. County .
Occupant
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Power Supplier
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Elecfrical Conhacror (Company Name)
TSEG,ECTi2 /�
Mailing Address (Conkacfor or Owner
$7�0 -�5'��
Authorized Signature (Confractor or O�
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E&OOOOIA-11 8/96 �
Address
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Phone No.
License No.
Installation)
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iing Installafion) h � � � p
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iD COPY - SEE INSTRUCTIONS ON BACK OP YELLOW COPY
Lic.