P - 81551,
���C���238 �
Nome Duplex
ommercial Industrial
Air C�: tg. Equ
Dryer Range
"X" above the work covered b
RE(�UEST FOFi ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 =
Phone (612) 64 -08� " '
Apt. Bldg. Other� � New Addn
Farm ` � Remod Re air
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Requesi will rot be accepted without fhe 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 ON�v TOTAL `^�
� ��
Sign/Outline Ltg, Xfmr.
Alorm/Remote Control
Swimming Pool
I hereb certi that I ins fhe elechical inslallafion described herein on the dares staled
Irri9afion Boom Rough-In _ Dare
Special Inspecti
Pinal - Dat � G�
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITNIN 18 MONTHS.
OFFlCE USE ONLY This roquest void 18 months from validation date printed in this box.
i iiii ii iil ii iii ii iii ii iii ii ii�i iii ii �i i i�i ��a ��- •►
* � 8 0 2 2 3 8�� o�/$(�
PLEASE PRINT OR TYPE
Request D Rou Irin ins on r uired?
/� � � g pecli eq ❑ Yes . o Inspection OFher Than RougMn: ❑ Ready Now Will Call
�You must call ihe inspector when ready) Date Reody:
I, ❑ icense contractor �owner hereby request inspection of the above elechical work at:
Job Address Sfreet, Box Route o.' Ciy ,� Zip Code
° � S�- �C � � ' � s`�2J
$ecfion No. Township Name or No. Range No. � Fire No. County � ,1
VJ � �� � �� �
Power Supplier J �� � Addreyq,/
1� � � Y
Elecfrical ConhacfoF (Company Name) Conhacfor License No. Masfer Lic, -No. (Plant Elecl. O
Moiling Address �Conhacfor or Owner Performing Installation) A�� � �
. `
Auth ed Signafure (Con c r or Own rforming Installation) ��o. �,/�
��
1 A-11 6 STATE BOARD COP ,- E INSTRUCTIONS ON BACK OF YELLOW COPY