P - 84423. � -
n REQUEST FO ELECTRICAL INSPECTION
�"* ��-18 2 Minnesota State ard of Electricity -�
1821 Universi Ave., Rm. S-128, St. Paul, MN 55104
Phone (612 2-0800
Home Duplex Apt. Bldg. Other: •.
Commercial In usfriol Farm Ne�'" Addn
Air Cond. tg. Equip. Woter Htr. Load M mt. Remod Re ir
9 Other:
��Yef Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in ihis s ace and on the back of the whiie co on
P PY �Y-
Calculaie /nspection Fee - This Inspe
Other Fee
Mobile Home Park Stall
Street Ltq./Traffic S�n
����� � � � ���
on Request will not be accepted without the correct fee:
# Service Entrance Size Fee # Circuits/Feeders
0 to 200 Amps F�
0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY
�ign/VuHine Ltg. Xfmr. TOTAL �
Alarm/Remote Conhoi � •
Swimming Pool
Irrigation Boom � h�eb certi thot I ins the electrical installafion described herein on the dates sfated
RougMn
Speciai inspectio � pa�
Investigative Fee F'"O�
• �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLy This reyuest void 18 monfhs from validafion date printed i� this box.
�IIIIIIIIIIII�IIII � . . ��
�����III II�������� �
�������������� r� �-- ��
� 0 4 L 5 1 8 2 5* �
Req„esr pore PLEASE PRINT OR TYpE
_�/� � Rough-in inspecfion required2 ❑ yes No Inspecfion O�er Than Rou h-In: �
� (You musf call fhe inspecfur when ready) Date Read : 9 ❑ Ready Now ill Call
Y
I, licensed confractor ❑ owner hereby request inspection of the above elecfricol work at:
Job Addreu �Sheet, Box, r Roufe No.� �_/ � �
�/ 7� [J/ : CIy r'/�/ za c�
Seclion No. Township Name or No. ���� �
Range No. Fire No C
Power
` � ou ��
Phone No.
� �� / l� � �
Airvt M7r,:-A/C & ELECT. [N;:.
13b62 CENTRAL AVE. N.E.
� STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
Masfer Lic.
No.