P - 80655REGIUEST FOR ELECTRICAL INSPECTION °'E
7��� Q�� � Minnesota State Board of Electricity
V 1821 University Ave., Rm. S-128, St. Paul, MN 55104 -
Phone (612) 642-0800 a'�'�
Home Duplex Apt. Bldg. Other: New Addn
Commercial Indusirial Farm Remod Re air
Air Con . Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above fAe work covered by this request. Enter remarks in fhis space and on ihe back of the white copy only.
�.;�����,�
Calcufate Inspecfion Fee - This lnspection Request will rtof be accepied without 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 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL Jr_��
Sign/Outline Ltg. Xfmr. ���'°�'�
Alarm/Remofe Control �
Swimming Pool
I hereb certi thot I ins ected the electrical installation described herein on fhe dates sta
Irrigation Boom RougMn Dote
Special Inspecti
Final � � Date� " ��. �d
Investigative Fe
THIS INSTALLATION MAY BE ORDERED DISCONNECTE F NOT COMPLETED WITHIN 18 MONTHS.
_ _ _ _ _ _ _ _ _ __ __ - - �— _— _- — --
� OFFlCE USE ONLY This requesf void 18 months 6om validafion dafe prinied in this box.
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIi�I�hl�INl�il � �6-�
* 0 7 7 2 & 2 3]� * 3�j`� I
PLEASE PRINT OR TYPE
Reque�� � Rou h-in ins tion re uired? s �
g pec q ❑ No fnspection Olher Than� Rough-In: dy Now 0 Will Call
(You musf call the inspecfor whe ready) Date Ready:
I, ' nsed contractor ❑ owner hereby request inspection of the above elechical work at:
Job dre s frcef, Box, or oufe No.� City Zip Code
�V � I� 'L./ !�iVL ✓� C/ 1 Y� A vi r�U �...F�
SecTon No.
Occupant
%
�
� Name or No, " Ranye No.
i � �� r
� �� �� Address �
�mpa�N�e� .
/ �� .
'cfor or ner Performing Instal fi� ��
�
o�iractor or er Peri rming Insfallation)
% /�
i
TE BOARD OPY - SEE INSTI
�V �
lice�o, a�, ^ Master Lia No. (P
:ej aj j
t v
'� � n/ (S � G
Phone No. �
�
BACK OF YELLOW COPY