P - 84516�F`i-756
REQUEST FOR ELECTRICAL iNSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
New
�.
;`�,....
��1.
��
Commercial Indushial Farm Remod Re
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 ihe back of the whiie copy only.
��,'�,�,�- �� �' .����� ,5-�-�-l-
� ��,� � �- ���,,�
Calculate Inspection Fee - This Inspection Request will not be accepted 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 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL �
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irrigation Boom
SD2C I4I If1SDECf10G1 l�.
fhe eleclrical installation described herein on rhe dafes sfated
Date
THIS INSTALLATION MAY BE ORDERED DISCONNEC{ED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 months 6om validation date prinfed in this box.
%� /�' S� � �17a-�
�����N���������������������� IIII) ��������������
* � i Ea 1 7 5 6 9�C PLEASE PRINT OR TYPE
Reques Dafe Rough-in inspecfion required? ❑ Yes
I/ ��' /� ❑ No Inspecfion Olher Than RougMn:
J � �You must call the inspecfor when ready) Dafe Ready:
I, icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheef, Box, or Route No.) C�
�l % '�' ry-�i C� ��
Secfion No. Township Nam or o. Range No. Fire No. CounN /'1
Power Sup dier `
Elechical Confrador (Company Name)
Mailing dress� nhactor or Owye�
2.�1�''J �O�-�t �
� a re onhacfor or O�
Phone No.
t .�
Address
n /j
`
�tallaii9") �) ,
Master
���
( ms nanonl J 7� (,�� I P
���. R,! V
�_ +�Y-�-L �
BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
Now ❑ Will Call
z�P code
_5��32
7 --��c�