P - 79558REC,IUEST FOFR ELECTRICAL INSPECTION °'E
EJ l,t �= 3 2 2� Minnesota State Board of Electricity
. 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �:
Phone (612) 642-0 00
Home Duplex Apt. Bldg. Other: �� � New Addn
Commercial Industrial Farm i Remod Re air
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 the back of ihe white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted withouf the correct fee;�, Q
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 /' �1
Sign/Outline Ltg. Xfmr. ,RC L� .+,. U
Alarm/Remote Conhol
Swimming Pool
I�hereb certi thaf I ins ed the elechical insfallation described herein on the dates sTated
Irrigation Boom o„9�„ '
Special lnspection t
Investigative Fee F.r' �°�� �2 G
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OfFICE U8E ONLY This request void 18 monlhs 6om validation date printed in this box.
I���I II I�� II III �I I�I II �II I� III II �II � I� � 11� I�
* 0 8 0 2 3 2 2�* ��a��8� ��,J�b
PLEASE PRINT OR TYPE
Requesf Dafe Rou IFin ins �on r uired? � Yes
S— �^ D� g pecf eq ❑ No Inspection Other Than Rough-In: ❑ Ready Now Will Call
(You must call the inspectw when ready) Dote Ready:
I, ❑ licensed contractor owner hereby request inspection of the above elechical work at:
Job Address (Skeef, Box, or Rouie No.) City Zip Code
� 7 Sb /''1i¢-c�c So nI S 7� /v � � r i�Q %2 S Y o/
Seclion No. Township Name or No. Range No. Fire No. Couny
-36 2 Y .r/s %%4-
�� �� se �Ne -
� /'�!/ � \ `Y� /� � a ! /� �/(/ Phone No. � ^57�� .� 7 Q �
�
Power Supplier Address
-� .-.
E ' f Conhactor (Compan Conkacfor License No. Master Lic. No. (Plant Elect. Only)
- � �e, i � w�✓e �
Mailing Address (Conhactor or Owner Performing Installafion)
6 �s-� �r.�Q��a � sf �l= � - �.�� `�P /'� �'�
Aufhorized 'gnafure �Conhaclor or Owner Performing Insfallafion� Phone No.
� � 763 -s7i- s'7Qa
E 1 A-11 8/96 �7pTE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY