P - 83372REGIUEST FOR ELECTRICAL INSPECTION ��
7 0 c e�[ C � Minnesota State Board of Electricity 3
C� J J 1821 University Ave., Rm. S-128, St. Paul, MN 55104 ���`
• Phone(612)642-0800 �'�'
Air
Dry
"X" ab
Duplex Apt. Bldg. Other: New
Industrial Farm Remod
Htg. Equip. Water Htr. Load Mgmt. Other:
Range Elec. Heat Temp. Service
overed by this request. Enter remarks in this space and on the back of the white copy
�� 7i,�,,��, G�:� Grn�' -
Calculate Inspection Fee - This Inspection Request will not be accepted withouf the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park StaN 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�Y TOTAL -
Sign/Outline Ltg, Xfmr.. �
Alarm/Remote Confrol � S�
Swimming Pool
- I hereb certi thaf I ins cfed the elxhical installafion described herein on fhe dates stafed
Irrigation Boom RougMn Dare
Speciallrispecti �
Final � /
Investigative Fee (�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 1 S months from vafidation date prinfed in this box.
��IN�I��I��������������i�����II���� ! �o, sz�
�I��
* 0 7 0 6� '2 5 5 7* 7� l�
PLEASE PRINT OR TYPE
Request Date Rough-in inspection required$ ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now � Will Call
� � � �You must call the inspecror when ready� Date Ready:
I, icensed contrpctor ❑ owner hereby request inspection of the above electrical work at:
.
ob Address (Sheet, Box, or Route No.) . Ciy Zip Code
- MH t son ��� ,�� i �
Secfion No. Township Name or �No. Range No. Fire No. C
�n oke
�r�dltc, /n�
Power Supplier
tCa l �en t �i^
Address
�
C
Performing Installa� or� �'�
Phone No. ��.
Conkacfor License No.
�%i�0 C7 �D
r ������rY�" ! a 4t.r' � ` �J �"�V' .
�Confractor or n Performing Installation) �/'� n�� P
h v
STATE BOARD COPY - SEE INSTRUCTIONS ON B14CK OF YELLOW COPY
/ � �,
�"���d