P - 83095REQUEST FOR ELECTRICAL 4NSPECTION �
6��� Q�� � Minnesota State Board of Electricity
�� 1821 University Ave., Rm. 5-128, St. Paul, MN 55104
� Phone 612 42- �
( ) 6 0800
Home Duplex Apt. Bldg. Other: New Addn
Comme�cial Industrial Farm o I^ C, Remod Re air
Air Cond. Htg. Equip. Woter 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 the white copy only.
Calculafe Inspection Fee - This Inspection Request will not be accepted wifhout 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�Y TOTAL
Sign/Outline Ltg. Xfmr. � U,�,� .� ���f _�2 8'�
Alarm/Remote Control ��7 (r32�' 30 , Jt�
Swimming Pool
' I hereb certi ihat I ins the elecirical installation described herein on the dates stated
Irrigation Boo Rou Mn s
Special Inspec n 1 f"� 9 �� "/
Final
Investigative Fee �_ -�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WI HIN 18 MONTHS.
OFFICE USE W7LY This request void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
R�st Date Rou h-in ins fion r uired$ es
�,' g pec eq ❑ No Inspecfion Other Than Rough-In: ❑ Ready Now ill Call
^ �� i �`(ou musf call ihe inspector wh n ready) Dafe Ready:
I, �censed contractor ❑ owner hereby request inspection of the above electrical work at:
Job A ress �Sfreet, Box, or Rou No. City Zip Code
S� � c ,J E-"
Secfion No. Township Name or No. Range No. Fire No. County
Occupant Phone No.
��-LC�r-
Power $uppiier Addreu
✓�
Elecfrical ConNacfor �Company Name) Conhaclor License No. Master Lic. No. (Planf Elecf. Only)
� ' �4c�a/83 0
U ,
Mailing Address (Conhacfor or Owner Performing Insfallafion)
� /' �� _ �' ��l ��- �!' � ,�.�/.�
�on� ' " ' Phone No.
2 � �:� il,? * `1���r
- SEE INSTRUCTIONS ON BACK OF YELLOW COPY