P - 83261• •
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REQUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Electricity � �_
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �.
Phone (612) 642-0800 v���
Other: New �Ad�
ommercia n ustrial Farm Remod Re
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heaf Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
F�cnn� �Qe/�/AC�rr�IT
Calculate Inspection Fee - This Inspeciion 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 , o d
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps f S Z
Transformer/Generator IMSPECTOR�s use oN�r TOTAL
Siqn/OuAine Ltq. Xfmr. �,5 i ��
mote Control
� Pool
I hereb certi that I ins the elechical installation described herein on the da
Boom RoupMn pafe
Investigative Fee— `" �"�^' " �'�� �_�=���_ � � � " ��^Q�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
. OFFICE USE ONLY This requast void 16 months from validaiion da�e printed in fhis box.
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PLEASE PRINT OR TYPE
Request Dafe Rough-in inspecfion required? ❑ Yes No Inspecfion Ofher Than Rough-In:
:�1R�,y 98' �You must call the inspector when ready� Date Ready: f%„al� a
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I,�licensed confractor ❑ owner hereby request inspection of the above electrical work at:
1ob Address (Str�t, Box, w Route No.) "
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SecFion No. Township Name or No. Range No. Fire No. County
Occupont
f i�tvA� .q �,°L- ki4�2//h
Power $upplier
Elechical Conhacfor �Company Name�
or
� 8�96 STATE BOARD
Ready Now ❑ Will Cal�
Zip Code
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Phone No.
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ON BACK OF YELLOW COPY