P - 8072157- -319 �
Home Duplex
Commercial Industrial
Air Cond. Htg. Equ'
Dryer Range
"X" obove the work covered b
w 1t� %21
Calculaie Inspection Fee - This Inspf
Other Fee
Mobile Home Park Stall
Street Ltg./Traffic Sig.
Transformer/Generator
Siqn/Oudine lta. Xfinr.
RE�UEST FOR ELECTRICAL INSPECTION -
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Farm
Water Htr. Load Mgmt. Other:
Elec. Heot Temp. Service
request. Enier remarks in ihis space and on
��d� ��? vv1
New
Remod
white copy
m Request will not be accepted withoui the correci fee:
# Service F,ntrance Size Fee # Circuits/Feeders
to 200 Amps 0 ro 100 Amps
Above 200 Am s Above 100 Ai
NiSPECTOR'S USE ONLY TOT,
Fee
�_J ■
Swimming Pool
I her certi that I ins �e elechical'ns�allalion described herein on lhe da�es sMled
Irrigafion Boom Rough-In Da�e ` t�
$peciallnspecti i' r C
Investigative Fee F�� �� —/G -�3
THIS INSTALLATION MAY BE ORDERED DIS�W�INECTED IF NOT COMPLEiED WITHIN i8 MONTHS.
OFFICE USE OPILY This request void 18 months kom validafion date printed in this box.
jI,I{,`I '�,�0 ��,3fC! �
(IIII�IIIII�IIIIIIII�IIII� ��Illullllllll
�: O 5 7 5� L 9 9* PLEASE PRINT OR TYPE
Request �' � Rough-in inspection required? Yes ❑ No Inspection Ofher T}�an RougFrin: � Ready Now ill Call
(You must call the inspecta en ready� Date Ready:
I, licensed conhacror ❑ owner hereby request inspection of the above electrical work at:
�Street, Bo�c, Route No.} Ciy � Zip Code
��2/ � �� � ti� rf/�b z �`� �'
$eciion No. Township Na No. � Range No. Fire No. Counly
<30 o2Y ,� Ur � �-�
I P / �+
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Mail' Address (Conhac�w a Owner
�`7 �' 6 /�A,
�' Z! �
Conhacroi
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ning Installafion�
��� �°�ryl S -
7 d 33
� Mas�er lic. No. (Plnnt
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STATE ARD COPY - SEE INSiRUCTIONS ON BACK OF YELLOW COPY �